Brain death: medical management in seven Brazilian pediatric intensive care units

Abstract

NEEP-Br) 9Resumo Objetivo: Avaliar a incidência de morte encefálica (ME), bem como as condutas e protocolos adotados após confirmação diagnóstica em sete unidades de tratamento intensivo pediátrico (UTIP) localizadas em três regiões brasileiras. Métodos:Estudo transversal e multicêntrico baseado na revisão e análise retrospectiva de prontuários de todos os óbitos ocorridos entre janeiro de 2003 e dezembro de 2004 em sete UTIP localizadas em Porto Alegre (duas), São Paulo (duas) e Salvador (três). Dois residentes de cada serviço previamente treinados preencheram protocolo padronizado avaliando dados demográficos, causa do óbito, critérios para diagnóstico de ME e conduta médica adotada. Resultados:Identificamos 525 óbitos, sendo 61 (11,6%) com diagnóstico de ME. A incidência de ME diferiu entre as sete UTIP (24,2 a 4,5%; p = 0,015), porém sem diferença nas três regiões (12, 15 e 7%; p = 0,052). A causa mais freqüente foi hemorragia intracraniana (31,1%). Em 80% dos casos, o diagnóstico clínico de ME foi confirmado por exame complementar (100% na Região Sul, 68% na Sudeste e 72% na Nordeste, p = 0,02). A retirada de suporte vital após diagnóstico de ME diferiu nas três regiões, sendo mais rápida (p = 0,04) no Sul (1,8±1,9 h) que no Sudeste (28,6±43,2 h) e Nordeste (15,5±17,1 h). Apenas seis (9,8%) crianças com ME foram doadoras de órgãos.Conclusão: Apesar da lei que define critérios para ME existir no Brasil desde 1997, verificamos que ela não é obedecida uniformemente. Conseqüentemente, suporte vital desnecessário é ofertado a indivíduos já mortos, existindo ainda um modesto envolvimento das UTIP com doações de órgãos.J Pediatr (Rio J). 2007;83(2):133-140: Morte encefálica, doação de órgãos, terapia intensiva pediátrica, ética médica. AbstractObjective: To assess the incidence of brain death (BD) and its medical management and adopted protocols after its diagnosis in seven pediatric intensive care units (PICUs) located in three Brazilian regions. Methods:A cross-sectional and multicenter study was conducted, based on the retrospective review of medical records regarding all deaths that occurred between January 2003 and December 2004 in seven Brazilian PICUs of tertiary hospitals located in Porto Alegre (two), São Paulo (two) and Salvador (three). Two pediatric intensive care residents from each hospital were previously trained and filled out a standard protocol for the investigation of demographic data, cause of death, diagnosis of BD, related protocols and subsequent medical management.Results: A total of 525 death patients were identified and 61 (11.6%) were defined as BD. The incidence of BD was different (p = 0.015) across the seven PICUs, but with no difference across the three regions. Intracranial hemorrhage was the most frequent cause of BD (31.1%). In 80% of the cases the diagnosis of BD was confirmed by complementary exams (south = 100%, southeast = 68% and northeast = 72%; p = 0.02). The interval between the diagnosis of BD and the withdrawal of life support was different (p < 0.01) across the three reg...

Brain death and organ donation in Argentine pediatric intensive care units. A multicenter study

“…6 It is worth noting that, in this study, 30% of cases of clinical BD (44 out of 147) were not certified using ancillary methods, which harbors the potential for lost donors, which is higher than what has been reported by a multicenter study conducted in Brazil, 13 which showed that 20% of BD cases were not certified. It has been considered that the implications of adopting a health policy in relation to mandatory ancillary methods are subjected to ethical and cultural conditions inherent to each country and are worth discussing in the scientific society as a whole.…”

Brain Death in Children: Incidence, Donation Rates, and the Occurrence of Central Diabetes Insipidus

“…The median duration of hospitalisation was 12 days (IQR: [9][10][11][12][13][14][15][16][17] pitalisation and the start of BD evaluation was seven days (IQR:5-10.5), and the median duration of brain death evaluation was three days (IQR:2-7). In the current study, we first confirmed BD in patients by clinical criteria then performed a confirmatory ancillary test.…”

“…Different pediatric studies have found different rates between 11.6% and 37% [11][12][13]. These differences may be due to the type of ICU, e.g., trauma referral centres, local practice differences such as the emphasis on organ donation, comfort with the determination of BD, the year of study, and patient demographics.…”

“…In most studies, the most common finding in children is reported to be traumatic brain injury [12,4,13,14]. Some studies have found a high prevalence of infectious diseases [15] and cerebrovascular accidents [11].…”

Morte encefálica: uma discussão encerrada?

“…Based on various philosophical principles, these parameters stipulate variable intervals between clinical trials, various assignments of the professionals in charge of carrying out such tests and whether or not the execution of additional procedures are necessary 5 . A certain uneasiness is still frequent among the professionals involved, especially among critical care physicians, at the time of suspension of life support or at the time of filling in the death certificate 6,7 .…”