CURRENT Essentials of Critical Care.pdf

Chapter 3 Ethical Issues 31■■■Brain DeathEssentials of Diagnosis• Irreversible cessation of brain function, cortical and brain stem• Brain stem: no oculocephalic reflex, pupils fixed, lack of motorreflexes, absence of spontaneous respiration• No spontaneous breathing for 10 minutes after discontinuingmechanical ventilation (patient given 100% O 2 to breathe)and/or PaCO 2 55 mm Hg• Local or institutional policy may require determination by neurologistor neurosurgeon, need more than one examiner, requiretwo examinations conducted at a defined interval, or mandateelectroencephalogram (EEG)Differential Diagnosis• Hypothermia• Presence of sedative-hypnotic drugs (benzodiazepines, barbiturates,etc.).• Severe vegetative state (some brain stem function)Treatment• Determine if brain death is present by institutional or local criteria• According to institutional procedure, determine and act accordinglyif patient is potential organ donor• If brain death declaration is made, time of death is time determinationmade• Remove life support therapy after declaration of death, exceptfor organ donation■ PearlWhen testing for apnea, give 100% oxygen through the endotrachealtube to avoid hypoxic injury, then observe for at least 10 minutes oruntil the PaCO 2 rises above 60 mm Hg.ReferenceWijdicks EF: The diagnosis of brain death. N Engl J Med 2001;344:1215.[PMID: 11309637]