scholarly journals Anaesthetic management of ASA 6 patients

2016 ◽  
Vol 63 (2) ◽  
pp. 75-77 ◽  
Author(s):  
Marijana Zivkovic ◽  
Vanja Misic ◽  
Mirjana Lausevic ◽  
Miodrag Milenovic ◽  
Branislava Stefanovic
Keyword(s):  
Intensive Care ◽  
Brain Death ◽  
Organ Donor ◽  
Serum Levels ◽  
Anaesthetic Management ◽  
Hemodynamic Stability ◽  
Potential Organ Donor ◽  
Brain Functions ◽  
Acid Base Status ◽  
The Stability

The criteria to determine brain death include circulatory-respiratory criteria-loss of circulation and respiration and neurological criteria - irreversible cessation of all brain functions. After brain death is proven, intensive care is directed from nonspecific neuroprotection to somatic organs protection. Access to the maintenance of the potential organ donor began achieving rapid hemodynamic stability with the monitoring and correction of serum levels of electrolytes, glucose and lactate, acid-base status, determining and maintaining body temperature-deceased patients with a beating heart are poikilothermic and their temperature depends of the surrounding temperature and analysis accompanying comorbidity and its possible impact, especially on the stability of the cardiovascular system. The result of intensive care and good maintenance of these patients are good quality organs for transplant.

scholarly journals Caring for a potential organ donor at an intensive care unit: the role of the nurse

2017 ◽  
Vol 11 (2) ◽  
pp. 35-39
Author(s):  
Sylwia Kosek ◽  
Anna Klimczyk
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Death ◽  
Organ Donor ◽  
Loss Of Function ◽  
Potential Organ Donor ◽  
Difficult Conversations ◽  
The Family ◽  
The Individual

Brain death causes irreparable loss of function of the brain as whole and is tantamount to the individual death. According to the governing laws in Poland, a committee composed of three consultants, including a specialist in anaesthesiology and intensive care and a specialist in neurosurgery or neurology, states the individual death. Stating brain death has occurred discharges doctors from their obligation to continue therapy. In the event the organs can be harvested for transplant, after ruling out the objection of the deceased and medical counter indications, medical staff continues to care for the donor during the period of preliminary observation, diagnostics and establishing brain death, and later for the deceased, until the organs are harvested. It includes all activities, from monitoring to therapy, diagnostic and nursing activities. Nurses play an important role in the team providing care to a donor. The nurse should have extensive knowledge about brain death, its course and results, as they play an important role in proper diagnostic procedure and providing proper care until the organs are harvested. Strict nursing supervision of the donor allows the staff to detect deviations in the functioning of the organism early. The aim of this paper was to present the procedures concerning declaring brain death and portraying the role of a nurse in caring for a potential organ donor at an intensive care unit. Conclusions. Proper procedure is paramount in harvesting good quality organs for transplantation and assuring their proper functioning later. It is worthwhile to note the role of the nurse in contacts with the family, as cooperation with the donor’s family is an important aspect of the process, especially the ability to conduct difficult conversations.

Brain Death and Resuscitation of the Organ Donor

2017 ◽  
Author(s):  
Kasra Khatibi ◽  
Chitra Venkatasubramanian
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Brain Death ◽  
Organ Donor ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Potential Organ Donor ◽  
Brain Dead ◽  
Donor After Brain Death ◽  
Apnea Testing

When is a patient brain dead? Under what scenarios in the surgical intensive care unit is brain death a possibility? Who can declare brain death and how? What are the steps after brain death declaration? You will find answers to all of these and more in this review. We will walk you through the principles, prerequisites, and techniques of clinical brain death evaluation using checklists and videos. The role and interpretation of ancillary testing and pitfalls are also discussed. New in this section is a description of the techniques that can be adapted when a patient is on extracorporeal membrane oxygenation. In addition, we have included a section on how to communicate effectively (i.e., what phrases to use) with families while discussing brain death and thereby avoid conflicts. We conclude with a detailed section on the physiology and critical care of the potential organ donor after brain death. This review contains 2 videos, 8 figures, 3 tables and 21 references Key words: Brain death, Apnea testing, ECMO, Organ donation

Physiologic Features of Brain Death

2017 ◽  
Vol 83 (8) ◽  
pp. 850-854 ◽  
Author(s):  
Eno-Obong Essien ◽  
Kristina Fioretti ◽  
Thomas M. Scalea ◽  
Deborah M. Stein
Keyword(s):  
Brain Death ◽  
Injury Severity ◽  
Organ Donor ◽  
Respiratory Dysfunction ◽  
Traumatic Injuries ◽  
Potential Organ Donor ◽  
Major Mechanism ◽  
Patient Demographics ◽  
Widespread Belief ◽  
Brain Dead

Brain death is known to be associated with physiologic derangements but their incidence is poorly described. Knowledge of the changes that occur during brain death is important for management of the potential organ donor. Thus, we sought to characterize the pathophysiology that occurs during brain death in patients with traumatic injuries. All brain-dead patients over a 10-year period were identified from the trauma registry at a level 1 urban trauma center. Patient demographics, injury characteristics, and clinical data for defining organ dysfunction were reviewed for the 24 hours surrounding brain-death declaration. Three hundred and seventy-three patients were identified. Mean age was 37 years (617.2). Seventy-five per cent were male. Major mechanism of injury was blunt trauma in 66 per cent. Median injury severity score was 34 (IQR 25–43) with a median head abbreviated injury scale score of 5. The most common physiological disturbance was hypotension with 91 per cent of subjects requiring vasopressors. Thrombocytopenia and acidosis both had an incidence of 79 per cent. The next most common disturbances were hypothermia and moderate-to-severe respiratory dysfunction in 62 per cent. Myocardial injury was seen in 91 per cent but only 5.7 per cent of patients manifested severe cardiac dysfunction with an ejection fraction of <35. Diabetes insipidus was diagnosed in 50 per cent of patients. Interestingly, coagulopathy was noted in only 61.3 per cent, and hyperglycemia was seen in 36 per cent despite widespread belief that these occur universally during brain death. This is the first and largest study to characterize the incidence of pathophysiological disturbances following brain death in humans. Appropriate management of these dysfunctions is important for support of potential brain-dead organ donors.

scholarly journals Identification of separation phenomenon during brain death determination of potential organ donor and analysis of relative factors

2020 ◽  
Vol 7 (5) ◽  
pp. 1347
Author(s):  
Guixing Xu ◽  
Ping Yu ◽  
Ping Xu ◽  
Donghua Zheng
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Brain Death ◽  
Organ Donor ◽  
Respiratory Arrest ◽  
Successful Implementation ◽  
Related Factors ◽  
Potential Organ Donor ◽  
Brain Death Determination ◽  
Death Determination

Background: With analyzing the incongruent phenomenon of electrical active and cerebral blood flow in brain death determination and screening the related factors, offer correct explanations and countermeasure to ensure the successful implementation of donation after brain death.Methods: Relevant clinical data of potential brain death organ donors were prospectively collected between June 2018 and May 2019. The related parameters of neurological examination, laboratory examination and neuroimaging examination during the period of brain death determination were dynamically recorded. Separation phenomenon was used as grouping factors to screen the factors related to separation phenomena through univariate and multivariate analysis.Results: According to the inclusion criteria, 127 patients were included in the study. Among 22 patients (17.3%) with incongruent phenomenon, 17 (77.3%) had electrical silence earlier than cerebral blood flow arrest, and 9 (22.7%) had cerebral blood flow arrest earlier than electrical silence. Univariate and multivariate analysis showed that age <14 years (OR=6.25, 95%CI 1.21-32.22, p=0.028),  SBP≥140 mmHg (OR=7.43, 95%CI 1.62-33.99, p=0.010), primary brainstem injury (OR=15.89, 95%CI 3.04-82.93, p=0.006), spontaneous respiratory arrest time ≤72 hours (OR=11.96, 95%CI 1.59-89.78, p=0.009) and decompression craniotomy(unilateral or bilateral) (OR=16.28, 95%CI 2.25-117.73, p=0.001) were associated with separation phenomenon..Conclusions: Separation phenomenon is a common during the confirmation test of brain death determination in China, and should be correctly recognized. To adopt corresponding measures according to risk factors is useful for successful implementation of donation after brain death.

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