TY  - CHAP
M1  - Book, Section
TI  - Brain Death Evaluation
A1  - Rozenfeld, Ranna A.
PY  - 2018
T2  - The PICU Handbook
AB  - Brain  death  in  infants  and  children  according  to  current  guidelines1:Brain  death  guidelines:  Defining  brain  death  originates  from  the  President's  Commission  of  the  Study  of  Ethical  Problems  in  Medicine  and  Biomedical  and  Behavioral  Research.  For  pediatric  patients,  the  most  recent  brain  death  guidelines  were  published  in  2011  by  a  multidisciplinary  taskforce  and  are  endorsed  by  the  Society  of  Critical  Care  Medicine,  the  American  Academy  of  Pediatrics,  American  Association  of  Critical  Care  Nurses,  Child  Neurology  Society,  and  Society  of  Pediatric  Neuroradiology.  This  definition  of  death  is  affirmed  by  the  American  Bar  Association.  Despite  wide  acceptance,  no  federal  brain  death  law  exists,  so  providers  must  review  their  state  and  institutional  statutes  and  policies  that  may  restrict  this  definition.Brain  death:Cessation  of  all  neurologic  functions  of  the  brain  due  to  a  known,  irreversible  cause.Clinical  Diagnosis:  This  is  a  clinical  diagnosis  and  must  be  made  by  a  physician  who  has  taken  the  history  and  completed  the  exam.  Coma  and  apnea  must  coexist.Clinical  examination:  Includes  evaluation  of  coma,  loss  of  brainstem  functioning,  and  apnea.Prerequisites  for  initiating  brain  death  evaluation:Irreversible  coma  with  known  cause:  Although  not  considered  ancillary  studies,  magnetic  resonance  imaging  (MRI)  or  computerized  tomography  (CT)  findings  should  show  evidence  of  acute  injury  consistent  with  significant  neurologic  damage.Hemodynamic  and  metabolic  stability:  Shock,  hypotension,  hypothermia,  and  severe  metabolic  disturbances  that  could  affect  neurologic  function  (i.e.,  glucose  and  electrolytes)  must  be  corrected  before  initiating  the  exam.Pharmacologic  agents:  Neuromuscular  blockades,  sedatives,  barbiturates,  opioids,  and  antiepileptics  must  be  discontinued  prior  to  the  examination.  For  recently  administered  medications,  adequate  clearance  should  be  allowed  (based  on  half-life,  organ  dysfunction,  and  patient  age).Cardiopulmonary  resuscitation:  It  may  be  necessary  to  wait  24  to  48  hours  after  cardiopulmonary  arrest  or  severe  acute  brain  injury  due  to  patient  instability  or  inconsistencies  in  neurologic  examinations,  as  assessed  by  clinical  judgment.Number  of  examinations:  Two  examinations  should  be  performed,  separated  by  an  observation  period.Neonates:  For  patients  37  weeks  up  to  30  days  of  age,  the  observation  period  between  two  exams  should  be  24  hours.  Due  to  open  sutures  and  fontanelles,  neonates  are  less  likely  to  have  as  significant  intracranial  hypertension,  leading  to  cerebral  ischemia  and  herniation,  as  older  children.Current  guidelines  do  not  include  information  for  preterm  infants.Infants  and  children:  For  infants  older  than  30  days  of  age  and  children  up  to  18  years  of  age,  the  observation  period  between  two  exams  should  be  12  hours.Special  considerations:  Should  there  be  a  desire  to  decrease  the  period  of  observation,  an  ancillary  test  may  be  considered.Examiners:  The  clinical  examinations  should  be  performed  by  two  different  attending  physicians,  each  with  expertise  in  neurocritical  care.  Because  the  apnea  exam  is  an  objective  exam,  it  may  be  performed  by  the  same  attending  physician.Neurologic  examination:  To  assess  loss  of  all  brainstem  reflexes.  The  following  are  consistent  with  cessation  of  brainstem  function:Absence  of  pupillary  response:  Midposition  or  fully  dilated  pupils  that  are  nonreactive  to  bright  light.Absence  of  bulbar  musculature:  Deep  pressure  on  the  condyles  at  the  level  of  the  temporomandibular  joints  and  at  the  supraorbital  ridge  produce  no  movement  of  the  facial  and  oropharyngeal  muscles.Absence  of  gag,  cough,  sucking,  and  ...
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/17
UR  - accesspediatrics.mhmedical.com/content.aspx?aid=1152488408
ER  -