Abstract:Sirs: The early criteria for brain death (BD) included the absence of all nervous system functions (i. e. cerebral and spinal death) [1]. However, the demonstration of spinal reflexes in brain-dead patients [2, 5-8, 12, 13] led to revision of the criteria and acceptance of these reflexes as compatible with the diagnosis of BD [10]. Although the first studies noted that the Babinski sign was not observed in BD [7, 8], reviews still state that it may be present [10, 15]. We studied the characteristics of the pl… Show more
“…[16][17][18][19][20][21] One Class III study of 144 patients pronounced brain dead found 55% (95% confidence interval [CI] 47-63) of patients had retained plantar reflexes, either flexion or "stimulation induced undulating toe flexion." 22 Another study documented plantar flexion and flexion synergy bilaterally that persisted for 32 hours after the determination of brain death. 23 Two Class III studies suggested that the ventilator may sense small changes in tubing pressure and provide a breath that could suggest breathing effort by the patient where none exists.…”
Objective:To provide an update of the 1995 American Academy of Neurology guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimes observed in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death?Methods: A systematic literature search was conducted and included a review of MEDLINE and EMBASE from January 1996 to May 2009. Studies were limited to adults (aged 18 years and older).
Results and recommendations:In adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 American Academy of Neurology practice parameter. Complex-spontaneous motor movements and falsepositive triggering of the ventilator may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain. Neurology
“…[16][17][18][19][20][21] One Class III study of 144 patients pronounced brain dead found 55% (95% confidence interval [CI] 47-63) of patients had retained plantar reflexes, either flexion or "stimulation induced undulating toe flexion." 22 Another study documented plantar flexion and flexion synergy bilaterally that persisted for 32 hours after the determination of brain death. 23 Two Class III studies suggested that the ventilator may sense small changes in tubing pressure and provide a breath that could suggest breathing effort by the patient where none exists.…”
Objective:To provide an update of the 1995 American Academy of Neurology guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimes observed in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death?Methods: A systematic literature search was conducted and included a review of MEDLINE and EMBASE from January 1996 to May 2009. Studies were limited to adults (aged 18 years and older).
Results and recommendations:In adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 American Academy of Neurology practice parameter. Complex-spontaneous motor movements and falsepositive triggering of the ventilator may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain. Neurology
“…However, since this comprehensive guideline became known, studies have largely focused on specific neurologic manifestations or type of confirmatory tests. [5][6][7] No detailed studies as yet have been published on actual hospital practice in a large number of patients pronounced brain dead. A review could identify concerns in key areas such as correctly followed procedures, physician involvement, and apnea testing.…”
Brain death declaration is frequent within the first 3 days of admission. It is usually performed in hemodynamically unstable patients requiring vasopressors and vasopressin. If preconditions are met, apnea testing using an oxygen-diffusion technique is safe. However, in 1 of 10 patients, an apnea test could not be completed and confirmatory tests were needed.
“…Mittels wiederholter Berührung der Kornea von der Seite mit einem Wattestäbchen wird der Versuch unternommen, einen [51]. Spontane, spinal-motorische Extremitätenbewegungen nach Hirnfunktionsausfall werden auch als Lazarus-Phänomen bezeichnet (nach der biblischen Geschichte von der Wiedererweckung des toten Lazarus durch Jesus).…”
Zusammenfassung
Mit der Vierten Fortschreibung der Richtlinie der Bundes?rztekammer zur Feststellung des irreversiblen Hirnfunktionsausfalls (?Hirntod?), g?ltig seit Juli 2015, erfolgte in einigen Aspekten auch eine Pr?zisierung in Bezug auf die Erhebung der klinischen Symptome. Insbesondere sind darin die zu pr?fenden Voraussetzungen ausf?hrlicher dargestellt, und es wurde eine Untergrenze f?r den Ausgangs-Wert des arteriellen Kohlenstoffdioxid-Partialdruckes vor Durchf?hrung des Apnoe-Tests festgelegt. Der vorliegende Artikel stellt auf aktuellem Kenntnisstand die pathophysiologischen Grundlagen sowie die praktische Durchf?hrung der klinischen Befunderhebung des irreversiblen Hirnfunktionsausfalls, einschlie?lich des Apnoe-Tests, sowie das Vorgehen bei eingeschr?nkter Untersuchbarkeit in detaillierter Form dar. Zudem werden die beobachtbaren ? und mit dem Hirnfunktionsausfall vereinbaren ? spinal-motorischen Ph?nomene und die Kriterien f?r deren Abgrenzung von zerebralen Reaktionen beschrieben.
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