389

Meert, Kathleen L.; Keele, Linda; Clark, Amy

doi:10.1097/01.ccm.0000457886.43974.af

Cited by 10 publications

(17 citation statements)

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“…22 In this cohort, the median time from PICU admission to death of 2.5 days was similar to previous reports. 7,8 Taking into account the recommended 12-hour observation period between brain death examinations, the initial brain death evaluation likely began approximately 36 to 48 hours after PICU admission, which conforms to the current guideline recommendation that the assessment for absence of all neurologic function after acute brain injury be deferred for 24 hours or longer. 4 Patients who were declared brain dead were more severely ill on PICU admission and had shorter LOSs than those patients who died by cardiopulmonary death.…”

Section: Discussionmentioning

confidence: 90%

“…Most patients declared brain dead (84.4%) in this study had relatively normal preillness neurologic status, which is similar to other studies. 7,21 Compared with children with cardiopulmonary death, the children declared brain dead were more likely to be male, 2 to 12 years old, and African American. The incidence of trauma was higher in children declared brain dead, which likely contributed to the male predominance.…”

Section: Discussionmentioning

confidence: 99%

“…Based on 2 small studies, the estimated prevalence of brain death is approximately 15% of deaths in large academic US pediatric intensive care units (PICUs). 7,8 Despite widespread medical, legal, and ethical acceptance, ongoing controversies exist with regard to the concept of brain death and procedures for its determination. 9-12 A quality improvement summit convened by the American Academy of Neurology to address contemporary concerns associated with brain death determination established a set of goals to improve public trust in the brain death determination process.…”

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confidence: 99%

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Epidemiology of Brain Death in Pediatric Intensive Care Units in the United States

et al. 2019

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IMPORTANCE Guidelines for declaration of brain death in children were revised in 2011 by the Society of Critical Care Medicine, American Academy of Pediatrics, and Child Neurology Society. Despite widespread medical, legal, and ethical acceptance, ongoing controversies exist with regard to the concept of brain death and the procedures for its determination. OBJECTIVES To determine the epidemiology and clinical characteristics of pediatric patients declared brain dead in the United States. DESIGN, SETTING, AND PARTICIPANTS This study involved the abstraction of all patient deaths from the Virtual Pediatric Systems national multicenter database between January 1, 2012, and June 30, 2017. All patients who died in pediatric intensive care units (PICUs) were included. MAIN OUTCOMES AND MEASURES Patient demographics, preillness developmental status, severity of illness, cause of death, PICU medical and physical length of stay, and organ donation status, as well as comparison between patients who were declared brain dead vs those who sustained cardiovascular or cardiopulmonary death. RESULTS Of the 15 344 patients who died, 3170 (20.7%) were declared brain dead; 1861 of these patients (58.7%) were male, and 1401 (44.2%) were between 2 and 12 years of age. There was a linear association between PICU size and number of patients declared brain dead per year, with an increase of 4.27 patients (95% CI, 3.46-5.08) per 1000-patient increase in discharges (P < .001). The median (interquartile range) of patients declared brain dead per year ranged from 1 (0-3) in smaller PICUs (defined as those with <500 discharges per year) to 10 (7-15) for larger PICUs (those with 2000-4000 discharges per year). The most common causative mechanisms of brain death were hypoxic-ischemic injury owing to cardiac arrest (1672 of 3170 [52.7%]), shock and/or respiratory arrest without cardiac arrest (399 of 3170 [12.6%]), and traumatic brain injury (634 of 3170 [20.0%]). Most patients declared brain dead (681 of 807 [84.4%]) did not have preexisting neurological dysfunction. Patients who were organ donors (1568 of 3144 [49.9%]) remained in the PICU longer after declaration of brain death compared with those who were not donors (median [interquartile range], 29 [6-41] hours vs 4 [1-8] hours; P < .001). CONCLUSIONS AND RELEVANCE Brain death occurred in one-fifth of PICU deaths. Most children declared brain dead had no preexisting neurological dysfunction and had an acute hypoxic-ischemic or traumatic brain injury. Brain death determinations are infrequent, even in large PICUs, emphasizing the importance of ongoing education for medical professionals and standardization of protocols to ensure diagnostic accuracy and consistency.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Epidemiology of Brain Death in Pediatric Intensive Care Units in the United States

et al. 2019

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“…Considering the modes of death, 118 (86.8%) patients died after F-CPR, while BD was reported in 18 (13.2%) of nonsurvivors. Median GCS was 11.00 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) and 121 (89%) children had a GCS of 8. One hundred and four (76.5%) children were received in an intubated state before admission, and all of the remaining children required intubation during their stay.…”

Section: Demographic and Clinical Characteristicsmentioning

confidence: 99%

“…8 Modes of death investigated in the literature include withholding life-sustaining treatment (WLST), brain death (BD), and failed cardiopulmonary resuscitation (F-CPR). Although WLST is the most common mode of death in Europe, the United States, and Australia among children in PICU, [9][10][11][12] WLST may not be considered ethical in other countries including Turkey. Different cultures, religions, laws, and professional attitudes may also be associated with different rates regarding modes of death 1,13,14 ; therefore, obtaining country-and center-specific data are crucial to identify potential measures for different populations.…”

Section: Introductionmentioning

confidence: 99%

Descriptive and Clinical Characteristics of Nonsurvivors in a Tertiary Pediatric Intensive Care Unit in Turkey: 6 Years of Experience

Karakaya

Boyraz

Atis

et al. 2023

J Pediatr Intensive Care

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The objective of this study was to identify the characteristics of nonsurvivors in a pediatric intensive care unit (PICU) in Turkey. This is a retrospective analysis of patients who died in a tertiary PICU over a 6-year period from 2016 to 2021. Data were drawn from electronic medical records and resuscitation notes. Mode of death was categorized as failed cardiopulmonary resuscitation (F-CPR) or brain death. Among the 161 deaths, 136 nonsurvivors were included and 30.1% were younger than 1 year. Severe pneumonia, respiratory failure, and acute respiratory distress syndrome (ARDS) (31.6%) were the most common primary diagnoses. The most common mode of death was F-CPR (86.8%). More than half of the subjects had been admitted from pediatric emergency departments (58.1%), and more than half (53.7%) had died within 7 days in the PICU. Patients admitted from pediatric emergency departments had the lowest frequency of comorbidities (p < 0.001). Severe pneumonia, respiratory failure, and ARDS diagnoses were significantly more frequent in those who died after 7 days (p < 0.001), whereas septicemia, shock, and multiple organ dysfunction were more common among those who died within the first day of PICU admission (p < 0.001). It may be important to note that patients referred from wards are highly likely to have comorbidities, while those referred from pediatric emergency departments may be relatively younger. Additionally, patients with septicemia, shock, or multiple organ dysfunction were more likely to die earlier (within 7 days), especially compared with those with severe pneumonia, respiratory failure, or ARDS.

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Terminal Withdrawal of Mechanical Ventilation in a PICU

Baird

Piracha

Lindeman

2023

J Pediatr Intensive Care

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Data regarding a terminal withdrawal of mechanical ventilation (TWMV) in pediatric patients, in particular the time to death, would be helpful to family and hospital staff. This retrospective case series will review the TWMV in pediatric intensive care unit (PICU) patients at our hospital between 2015 and 2020. There were 222 PICU deaths and 53 of these patients died following a TWMV. The time to death was <1 hour in 37 patients, from 1 to 24 hours in 12 patients, and >24 hours in 4 patients. Neither age nor the duration of mechanical ventilation prior to TWMV was associated with time to death. TWMV was complicated by concurrent withdrawal of cardiac support devices in 9 patients and by a recent cardiac arrest in 3 patients (1 of whom also had a cardiac support device withdrawal), and the time to death for these 11 patients was less than 1 hour (p = 0.01 vs. all others). The time to death for those without concurrent withdrawal of cardiac support devices or recent cardiac arrest was shorter in those with a higher fraction of inspired oxygen but was not associated with positive end expiratory pressure. Time to death following a TWMV was less than a day in more than 90% of our patients and was not associated with patient age or the duration of mechanical ventilation. However, in patients without a recent cardiac arrest or concurrent withdrawal of cardiac support devices, nearly 1 in 10 survived a TWMV for more than a day, while those with a recent cardiac arrest or concurrent withdrawal of cardiac support devices survived for less than an hour.

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389

Cited by 10 publications

References 0 publications

Epidemiology of Brain Death in Pediatric Intensive Care Units in the United States

Epidemiology of Brain Death in Pediatric Intensive Care Units in the United States

Descriptive and Clinical Characteristics of Nonsurvivors in a Tertiary Pediatric Intensive Care Unit in Turkey: 6 Years of Experience

Terminal Withdrawal of Mechanical Ventilation in a PICU

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