Yıl: 2019 Cilt: 11 Sayı: 4 Sayfa Aralığı: 509 - 516 Metin Dili: İngilizce İndeks Tarihi: 15-05-2021

Evaluation of BrainDeath inChildren:ASingleCenter Experience

Öz:
Introduction: Brain death is defined as a status of apnea, coma and the absence of brainstem reflexes, in addition to thepresence of electrocerebral silence (ECS) on an electroencephalography (EEG). Trauma and anoxic encephalopathy are themost common causes of brain death in children, with incidences of brain death reported to vary between 0.65–1.2 percent.A diagnosis of brain death can be made based on a detailed anamnesis, physical examination findings and supportive testresults. When pediatric patients are being evaluated by EEG, they should also be assessed in terms of medications, metabolicencephalopathy, hypothermia, electrolyte imbalance and acid-base imbalance.Patients and Methods: The presentstudy included patients who suffered brain death during hospitalization in the pediatricintensive care unit of Inonu University Turgut Ozal Medical Center between 2010 and 2017. The medical files of the patientswere reviewed retrospectively. All patients included in the study underwent an EEG and an apnea test was performed on allpatients. The cerebral blood flow (CBF) measurement was obtained through a Computerized Tomography Angiography(CTA), and all patients underwent a Magnetic Resonance Angiography (MRA) and a Transcranial Doppler Ultrasonography(TCD).Results: Of the 20 patients included in the study, nine (45%) were female and 11 (55%) were male, with a mean age of8.47±5.73 years. Of the total, seven patients presented with fulminant hepatitis, three with trauma, three with sepsis, twowith drowning, two with cerebrovaskuler disease (CVD), and one patient each with lymphoma, suicide and electric shock.The families of only two (10%) patients donated the organs of the deceased. Of the 20 patients, four were Syrian, and ofwhich were being monitored with the diagnosis of liver failure. An apnea test was positive in all patients, and in all patients,the EEG findings supported brain death. Imaging methods were carried out to demonstrate the absence of CBF flow in 11(55%) patients, and diabetes insipidus (DI) developed in nine (45%) of the patients with brain death.Conclusion: In conclusion, a multidisciplinary approach is required for the diagnosis of brain death. An evaluation oflaboratory findings and EEG results together with the findings of a physical examination is important, particularly in centerslike our clinics where more than 50 pediatric transplantations are carried out each year. The development of hypernatremiain patients with DI is now an important parameter in the loss of brain function.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. American Academy of Pediatrics, Task Force on Brain Death in Children. Report of Special Task Force: guidelines for determination of brain death in children. Pediatrics. 1987; 80: 298 –300.
  • 2. Nakagawa TA, Ashwal S, Mathur M, Mysore M. Society of Critical Care Medicine, Section on Critical Care and Section on Neurology of American Academy of Pediatrics; Child Neurology Society. Clinical report— Guidelinesfor the determination of brain death in infants and children: an update of the 1987 task force recommendations. Pediatrics. 2011; 128: 720-40.
  • 3. Nakagawa TA, Ashwal S, Mathur M, Mysore MR, Bruce D, Conway EE Jr, et al. Society of Critical Care Medicine; Section on Critical Care and Section on Neurology of the American Academy of Pediatrics; Child Neurology Society. Guidelines for the determination of brain death in infants and children: an update of the 1987 Task Force recommendations. Crit Care Med. 2011; 39: 2139-55.
  • 4. American Electroencephalographic Society. Guideline three: minimum technicalstandardsfor EEG recording in suspected cerebraldeath. J Clin Neurophysiol. 1994; 11: 10–3.
  • 5. Coker SB, Dillehay GL. Radionuclide cerebral imaging for confirmation of brain death in children: the significance of dural sinus activity. Pediatr Neurol. 1986; 2: 43–46.
  • 6. Ashwal S, Smith AJ, Torres F, Loken M, Chou SN. Radionuclide bolus angiography: a technique for verification of brain death in infants and children. J Pediatr. 1977; 91: 722-7.
  • 7. Garrett MP, Williamson RW, Bohl MA, Bird CR, Theodore N. Computed tomography angiography as a confirmatory test for the diagnosis of brain death. J Neurosurg. 2017; 17: 1-6.
  • 8. Drake M, Bernard A, Hessel E. Brain Death. Surg Clin North Am. 2017; 97: 1255-73
  • 9. Kainuma M, Miyake T, Kanno T. Extremely prolonged vecuronium clearance in a brain death case. Anesthesiology 2001; 95(4): 1023-4.
  • 10. Ostermann ME, Young B, Sibbald WJ, Nicolle MW. Coma mimicking brain death following baclofen overdose. Intensive Care Med 2000; 26(8): 1144-6.
  • 11. Gençpınar P, Dursun O, Tekgüç H, Ünal A, Haspolat Ş, Duman Ö. Pediatric Brain Death: Experience of a Single Center Turkiye Klinikleri J Med Sci. 2015; 35(2): 60-6.
  • 12. Au AK, Carcillo JA, Clark RS, Bell MJ. Brain injuries and neurological system failure are the most common proximate causes of death in children admitted to a pediatric intensive care unit. Pediatr Crit Care Med 2011; 12: 566-571.
  • 13. Joffe AR, Shemie SD, Farrell C, Hutchison J, McCarthyTamblyn L. Brain death in Canadian PICUs: demographics, timing, and irreversibility. Pediatr Crit Care Med 2013; 14: 1-9.
  • 14. Gündüz C, Şahin Ş, Uysal-Yazıcı M, et al. Brain death and organ donation of children. The Turkish Journal of Pediatrics 2014; 56: 597-603.
  • 15. Ashwal S, Serna-Fonseca T. Brain death in infants and children. Crit Care Nurse 2006; 26: 117-124, 126-128.
  • 16. Tsai WH, Lee WT, Hung KL. Determination of brain death in children—a medical center experience. Acta Paediatr Taiwan 2005; 46: 132-137.
  • 17. Alharfi IM, Stewart TC, Foster J, Morrison GC, Fraser DD. Central diabetes insipidus in pediatric severe traumatic brain injury. Pediatr Crit Care Med 2013; 14(2): 203-9.
  • 18. Shemie SD, Pollack MM, Morioka M, Bonner S. Diagnosis of brain death in children. Lancet Neurol 2007; 6: 87-92.
APA ASLAN M, KIRIK S, özgör b, Aslan N, GÜNGÖR S (2019). Evaluation of BrainDeath inChildren:ASingleCenter Experience. , 509 - 516.
Chicago ASLAN MAHMUT,KIRIK Serkan,özgör bilge,Aslan Neslihan,GÜNGÖR SERDAL Evaluation of BrainDeath inChildren:ASingleCenter Experience. (2019): 509 - 516.
MLA ASLAN MAHMUT,KIRIK Serkan,özgör bilge,Aslan Neslihan,GÜNGÖR SERDAL Evaluation of BrainDeath inChildren:ASingleCenter Experience. , 2019, ss.509 - 516.
AMA ASLAN M,KIRIK S,özgör b,Aslan N,GÜNGÖR S Evaluation of BrainDeath inChildren:ASingleCenter Experience. . 2019; 509 - 516.
Vancouver ASLAN M,KIRIK S,özgör b,Aslan N,GÜNGÖR S Evaluation of BrainDeath inChildren:ASingleCenter Experience. . 2019; 509 - 516.
IEEE ASLAN M,KIRIK S,özgör b,Aslan N,GÜNGÖR S "Evaluation of BrainDeath inChildren:ASingleCenter Experience." , ss.509 - 516, 2019.
ISNAD ASLAN, MAHMUT vd. "Evaluation of BrainDeath inChildren:ASingleCenter Experience". (2019), 509-516.
APA ASLAN M, KIRIK S, özgör b, Aslan N, GÜNGÖR S (2019). Evaluation of BrainDeath inChildren:ASingleCenter Experience. ORTADOĞU TIP DERGİSİ, 11(4), 509 - 516.
Chicago ASLAN MAHMUT,KIRIK Serkan,özgör bilge,Aslan Neslihan,GÜNGÖR SERDAL Evaluation of BrainDeath inChildren:ASingleCenter Experience. ORTADOĞU TIP DERGİSİ 11, no.4 (2019): 509 - 516.
MLA ASLAN MAHMUT,KIRIK Serkan,özgör bilge,Aslan Neslihan,GÜNGÖR SERDAL Evaluation of BrainDeath inChildren:ASingleCenter Experience. ORTADOĞU TIP DERGİSİ, vol.11, no.4, 2019, ss.509 - 516.
AMA ASLAN M,KIRIK S,özgör b,Aslan N,GÜNGÖR S Evaluation of BrainDeath inChildren:ASingleCenter Experience. ORTADOĞU TIP DERGİSİ. 2019; 11(4): 509 - 516.
Vancouver ASLAN M,KIRIK S,özgör b,Aslan N,GÜNGÖR S Evaluation of BrainDeath inChildren:ASingleCenter Experience. ORTADOĞU TIP DERGİSİ. 2019; 11(4): 509 - 516.
IEEE ASLAN M,KIRIK S,özgör b,Aslan N,GÜNGÖR S "Evaluation of BrainDeath inChildren:ASingleCenter Experience." ORTADOĞU TIP DERGİSİ, 11, ss.509 - 516, 2019.
ISNAD ASLAN, MAHMUT vd. "Evaluation of BrainDeath inChildren:ASingleCenter Experience". ORTADOĞU TIP DERGİSİ 11/4 (2019), 509-516.