BackgroundThe causes of brain death include cerebral herniation and brainstem ischemia. Neuroendocrine failure or a series of autonomic nervous system disorders are clinically recognized in the transition to brain death among patients with critical brain injuries. An accurate evaluation of these physiologic instabilities and biomarkers is essential to assess the severity and prognosis of pediatric brain injury as well as to initiate supportive care. This case report presents a detailed evaluation of the autonomic nervous system and endocrine function during the transition to brain death in infantile hypoxic-ischemic brain injury by analyzing the heart rate variability and endocrine status.Case PresentationA 1-year-old previously healthy boy went into cardiac arrest after choking on a toy at home. Although spontaneous circulation returned 60 min after cardiopulmonary resuscitation, no cerebral activity or brainstem reflexes were observed after 18 hospital days. The heart rate variability was assessed by analyzing the generic electrocardiogram data. Rapid spikes or drops in the total power of the heart rate variability, accompanied by a cortisol surge, as well as an alternating surge of high- and low-frequency domain variables were detected in the process of brain death.ConclusionThe heart rate variability assessment combined with endocrine provides a better understanding of the clinical course of patients undergoing brain death. It accurately detects the loss of brainstem function, which allows physicians to provide the appropriate supportive care.
Background: Role of specialist of pediatric critical care is signi cant, especially for management of congenital heart diseases because most critical cardiac patients have been cared by pediatric cardiologists or cardiovascular surgeons in Japan. Objects: To clarify future issues in the eld of critical care in pediatric cardiology by investigating current situation of board certi cation and medical insurance in Japan. Methods: In this study, we investigated relationship between board certi cation and situation of training centers for the board-certi ed intensivist with pediatric cardiologists, pediatric cardiac surgeons and pediatricians in Japan from databases of o cial registration in the website. Results: Only 0.6 of board-certi ed pediatricians and 1.1 of board-certi ed pediatric cardiologists obtained board-certi ed intensivist. Certi cation of training center is 56 in all pediatric cardiac hospitals and their training systems is not appropriate for pediatricians because of lack of pediatric intensive care units especially in most university hospitals or general hospitals. ere is a gap between cities and regional area in the number of board-certi ed pediatricians with board certi ed intensivists. Conclusions: Signi cant gaps of board certi cation and medical insurance are recognized among regional areas in Japan requiring improvement of system and current situation in the eld of critical care of pediatric cardiology.
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