Document Detail


Brain tissue oxygen tension in clinical brain death: a case series.
MedLine Citation:
PMID:  17592680     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Brain death is a clinical diagnosis often confirmed with supplementary tests. In this study, we examined the relationship between brain death and the partial pressure of brain tissue oxygen (PbtO(2)). We hypothesized that a sustained PbtO(2) of 0 is associated with brain death. METHODS: One hundred and twenty-six patients (Glasgow coma scale < or = 8, median age: 50 years) who underwent PbtO(2) monitoring were studied prospectively during a 2 year period in the neurointensive care unit at a university-based level I trauma center. PbtO(2), intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP) and brain temperature (BT) were compared before and after the diagnosis of brain death. RESULTS: Six patients (median age: 52 years) experienced brain death. In these patients, PbtO(2) decreased toward 0 mmHg as ICP increased and CPP decreased. PbtO(2) reached 0 only when there was clinical evidence for brain death. During the subsequent 12 hours until the second brain death examination, PbtO(2) remained 0 mmHg and did not respond to oxygen challenge. In addition, TCD examination demonstrated a 'to and fro' pattern consistent with brain death and cerebral circulatory arrest. PbtO(2) of 0 mmHg was observed in five non-brain dead patients. These episodes were transient (>30 minutes) and responded to an oxygen challenge, directed treatment or catheter replacement. DISCUSSION: A sustained (>30 minutes) brain PbtO(2) of 0 is consistent with brain death. We suggest that a sustained 'zero' PbtO(2) may be used to determine when a brain death examination is appropriate in the pharmacologically suppressed patient.
Authors:
Michael Louis Smith; George J Counelis; Eileen Maloney-Wilensky; Michael F Stiefel; Kathy Donley; Peter D LeRoux
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurological research     Volume:  29     ISSN:  0161-6412     ISO Abbreviation:  Neurol. Res.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2008-01-04     Completed Date:  2008-02-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7905298     Medline TA:  Neurol Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  755-9     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Blood Pressure
Body Temperature
Brain / blood supply,  metabolism*,  physiopathology
Brain Death / diagnosis*,  metabolism*,  physiopathology
Brain Injuries / diagnosis,  metabolism,  physiopathology
Cerebrovascular Circulation
Disease Progression
Female
Glasgow Coma Scale
Humans
Hypoxia, Brain / diagnosis,  metabolism,  physiopathology
Intracranial Pressure
Male
Middle Aged
Monitoring, Physiologic / methods
Oxygen / analysis,  metabolism*
Oxygen Consumption*
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Time Factors
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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