Confounding factors in brain death: Cardiogenic ventilator autotriggering and implications for organ transplantation

摘要: Summary Brain death is characterised by a flaccid, areflexic neurological examination; fixed, dilated and midpoint pupils total absence of intrinsic respiratory drive. A non-reversible clinical state or brain lesion must also be identified. Integral to diagnosis loss Following terminal brainstem herniation, cardiovascular hyperdynamic often occurs. This causes cyclical volume displacement within the chest in phase with cardiac cycle, causing oscillations gas flow patterns may reflected ventilator airway pressure waveforms. When these flow/pressure waveform meet exceed trigger sensitivity, breaths triggered In patient no apparent function who still triggering breaths, detailed analysis pressure/flow waveforms context assessment findings can identify autotriggering brain-dead patient. Undetected, cardiogenic results prolonged ICU stay potential transplantable organs. Collaborative practice aggressive surveillance determine all neurologic evaluate possible this population paramount minimise stay, reduce costs care, decrease family stress facilitate recovery Implications for • Delay determination prolong experience patients’ families. Possible confusion about on part members clinicians’ consequent raise false hope recovery. Time required care add financial possibly exceeding £3000.00 per day. Longer management times donors due increases risk losing potentially organs refractory haemodynamic instability. Apparent ventilations oscillation lead mistaken evaluation that herniation has not occurred delay appropriate, mechanism-specific care. intervals between event final declaration criteria are particular concern. Formal protocols take as long 6–24 hours, creating occurrence final, brain/brainstem pronouncement death.