Abstract
Amaç: Akdeniz Üniversitesi Tıp Fakültesi hastanesi Türkiye'nin önemli organ nakil merkezlerinden biridir. Bu çalışmada erişkin yoğun bakım ünitesinde (YBÜ) beyin ölüm oranı, izlemi, donör bakımı ve organ bağışı ile ilgili deneyimlerin paylaşılması amaçlanmıştır.
Gereç ve Yöntemler: Akdeniz Üniversitesi Tıp Fakültesi Anestezi ve Yoğun Bakım Ünitesinde Ocak 2003-Aralık 2016 tarihleri arasında beyin ölümü tanısı alan hastaların kayıtları retrospektif olarak incelendi. Bu kayıtlarda hastaların demografik özellikleri, başvuru tanıları, yoğun bakım koma skorları, laboratuvar değerleri, değerlendirme tetkiklerinin yöntem ve süreleri, konsültasyon süreleri ve sevk bilgileri yer almaktadır.
Bulgular: Çalışmamıza 136 (%66) erkek, 71 (%34) kadın hasta dahil edildi. Başvuru tanısında intrakraniyal kanama ilk sırada yer aldı. Bunu 56 (%27,05) ile subaraknoid kanama (SAK)ve 42 (%20,28) ile intraparankimal kanama izledi. Doğrulayıcı testler arasında SPECT (tek foton emisyonlu bilgisayarlı tomografi) ilk sırada yer aldı, 70 hastada (%33,81) kullanıldı. Serebral ölüm sonrası 27 (%13.04) hastada spinal refleks gözlendi. İki hastada (%0,96) Lazarus bulgusu vardı. Yetmiş bir (%34,29) hastada sempatik fırtına gelişti. Hastaların 122'sinde (%58,93) diabetes insipidus gelişti ve tüm hastalar medikal tedavi aldı. Ayrıntılı kayıtları bulunan 207 beyin ölümü vakasının 66'sı (%31,4) organlarını bağışladı.
Sonuç: Organ nakli hastalarında güven ortamı oluşturmak için ortak bir tanı protokolü gereklidir. Bu alanda daha fazla klinik araştırmaya ihtiyaç olduğunu yineliyoruz.
Keywords
References
- 1. Arsava E, Demirkaya Ş, Dora B, Giray S, Gökçe M, Güler A. Turkish Neurological Society-Diagnostic guidelines for brain death. Turk J Neurol. 2014;20:101-4.
- 2. Lewis A, Shemie SD, Sung G, Torrance S, Greer D. Author Response: Determination of Death by Neurologic Criteria Around the World. Neurology. 2021;96(17):827.
- 3. Pallis C. Whole-brain death reconsidered--physiological facts and philosophy. Journal of medical ethics. 1983;9(1):32-7.
- 4. Citerio G, Murphy PG. Brain death: the European perspective. Semin Neurol. 2015;35(2):139-44.
- 5. A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA. 1968;205(6):337-40.
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- 20. Yoshikawa MH, Rabelo NN, Welling LC, Telles JPM, Figueiredo EG. Brain death and management of the potential donor. Neurol Sci. 2021;42(9):3541-52.
- 21. Brockmann J, Vaidya A, Reddy S, Friend P. Retrieval of abdominal organs for transplantation. Journal of British Surgery. 2006;93(2):133-46.
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- 25. Frenette AJ, Williamson D, Weiss MJ, Rochwerg B, Ball I, Brindamour D, Serri K, D'Aragon F, Meade MO, Charbonney E. Worldwide management of donors after neurological death: a systematic review and narrative synthesis of guidelines. Can J Anaesth. 2020 ;67(12):1839-57.
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- 27. Holmes CL, Walley KR. Bad medicine: low-dose dopamine in the ICU. Chest. 2003;123(4):1266-75.
- 28. Ivan LP. Spinal reflexes in cerebral death. Neurology. 1973;23(6):650-2.
- 29. Jørgensen E. Spinal man after brain death. Acta neurochirurgica. 1973;28(4):259-73.
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Abstract
Objective: Akdeniz University Faculty of Medicine hospital is one of the important organ transplant centers of Turkıye. This study aimed to share experiences about cerebral death rate, follow-up, donor care, and organ donation in the adult intensive care unit (ICU).
Material And Methods: The records of patients diagnosed with brain death in the Anesthesia and Intensive Care Unit of Akdeniz University Faculty of Medicine between January 2003 and December 2016 were reviewed retrospectively. In these records, patients' demographic characteristics, admission diagnoses, intensive care coma scores, laboratory values, method and duration of evaluation tests, consultation times, and transport information are available.
Results: In our study, 136 (66%) male and 71 (34%) female patients were included. Intracranial hemorrhage was the first line in the diagnosis of admission. This was followed by 56 (27.05%) subarachnoid hemorrhage (SAH), and 42 (20.28%) intraparenchymal hemorrhage. Among the confirmatory tests, SPECT (single-photon emission computed tomography) was the first in 70 (33.81%) patients. Spinal reflex was observed in 27 (13.04%) patients after cerebral death. Two patients (0.96%) had Lazarus sign. Sympathetic storms developed in 71 (34.29%) patients. Diabetes insipidus developed in 122 (58.93%) of the patients and all patients received medical treatment. Sixty six (31.4%) of 207 brain death cases with detailed records donated their organs.
Conclusion : A common diagnostic protocol is required to create an atmosphere of trust in organ transplant patients. We reiterate that more clinical research is needed in this area.
References
- 1. Arsava E, Demirkaya Ş, Dora B, Giray S, Gökçe M, Güler A. Turkish Neurological Society-Diagnostic guidelines for brain death. Turk J Neurol. 2014;20:101-4.
- 2. Lewis A, Shemie SD, Sung G, Torrance S, Greer D. Author Response: Determination of Death by Neurologic Criteria Around the World. Neurology. 2021;96(17):827.
- 3. Pallis C. Whole-brain death reconsidered--physiological facts and philosophy. Journal of medical ethics. 1983;9(1):32-7.
- 4. Citerio G, Murphy PG. Brain death: the European perspective. Semin Neurol. 2015;35(2):139-44.
- 5. A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA. 1968;205(6):337-40.
- 6. Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA. 1981;246(19):2184-6.
- 7. Machado C. The concept of brain death did not evolve to benefit organ transplants. Brain Death. 2007:1-20.
- 8. Kıraklı C, Uçar ZZ, Anıl AB, Özbek İ. Yoğun bakımda beyin ölümü kesin tanı süresinin kısalmasının organ bağışı oranlarına etkisi. Yoğun Bakım Dergisi. 2011;1(1):8-11.
- 9. Spears W, Mian A, Greer D. Brain death: a clinical overview. J Intensive Care. 2022;10(1):16.
- 10. Karasu D, Yılmaz C, Karaduman İ, Çınar YS, Pekel NB. Beyin Ölümü Olgularının Retrospektif Analizi. Turkish Journal of Medical & Surgical Intensive Care Medicine/Dahili ve Cerrahi Bilimler Yogun Bakim Dergisi. 2015;6(2).23.
- 11. Battal M, Horoz A, Karatepe O, Çitgez B. Beyin ölümü tespitinde araştırma hastanesi deneyimi. Şişli Etfal Hastanesi Tıp Bülteni. 2013;47(2):59-62.
- 12. De Groot YJ, Wijdicks EF, van der Jagt M, Bakker J, Lingsma HF, Ijzermans JN, Kompanje EJ. Donor conversion rates depend on the assessment tools used in the evaluation of potential organ donors. Intensive Care Med. 2011;37(4):665-70.
- 13. Nair-Collins M, Miller FG. Commentary: false positives in the diagnosis of brain death. Cambridge Quarterly of Healthcare Ethics. 2019;28(4):648-56.
- 14. Nathan S, Greer DM, editors. Brain death. Seminars in Anesthesia, Perioperative Medicine and Pain; 2006: Elsevier.
- 15. Jeret JS, Benjamin JL. Risk of hypotension during apnea testing. Arch Neurol. 1994;51(6):595-9.
- 16. Kramer AH, Couillard P, Bader R, Dhillon P, Kutsogiannis DJ, Doig CJ. Prevention of Hypoxemia During Apnea Testing: A Comparison of Oxygen Insufflation And Continuous Positive Airway Pressure. Neurocrit Care. 2017;27(1):60-7.
- 17. Goudreau JL, Wijdicks EF, Emery SF. Complications during apnea testing in the determination of brain death: predisposing factors. Neurology. 2000;55(7):1045-8.
- 18. Saposnik G, Rizzo G, Vega A, Sabbatiello R, Deluca JL. Problems associated with the apnea test in the diagnosis of brain death. Neurol India. 2004;52(3):342-5.
- 19. Daneshmand A, Rabinstein AA, Wijdicks EF. The apnea test in brain death determination using oxygen diffusion method remains safe. Neurology. 2019;92(8):386-7.
- 20. Yoshikawa MH, Rabelo NN, Welling LC, Telles JPM, Figueiredo EG. Brain death and management of the potential donor. Neurol Sci. 2021;42(9):3541-52.
- 21. Brockmann J, Vaidya A, Reddy S, Friend P. Retrieval of abdominal organs for transplantation. Journal of British Surgery. 2006;93(2):133-46.
- 22. Lazzeri C, Bonizzoli M, Guetti C, Fulceri GE, Peris A. Hemodynamic management in brain dead donors. World J Transplant. 2021;11(10):410-20.
- 23. Nair-Collins M, Northrup J, Olcese J. Hypothalamic-Pituitary Function in Brain Death: A Review. J Intensive Care Med. 2016;31(1):41-50.
- 24. Rode F, Vučić M. Incidence of central diabetes insipidus in brain dead patients. Liječnički vjesnik. 2019;141(suppl. 1):0-0.
- 25. Frenette AJ, Williamson D, Weiss MJ, Rochwerg B, Ball I, Brindamour D, Serri K, D'Aragon F, Meade MO, Charbonney E. Worldwide management of donors after neurological death: a systematic review and narrative synthesis of guidelines. Can J Anaesth. 2020 ;67(12):1839-57.
- 26. Oras J, Doueh R, Norberg E, Redfors B, Omerovic E, Dellgren G. Left ventricular dysfunction in potential heart donors and its influence on recipient outcomes. The Journal of Thoracic and Cardiovascular Surgery. 2020;159(4):1333-41. e6.
- 27. Holmes CL, Walley KR. Bad medicine: low-dose dopamine in the ICU. Chest. 2003;123(4):1266-75.
- 28. Ivan LP. Spinal reflexes in cerebral death. Neurology. 1973;23(6):650-2.
- 29. Jørgensen E. Spinal man after brain death. Acta neurochirurgica. 1973;28(4):259-73.
- 30. Saposnik G, Bueri JA, Maurino J, Saizar R, Garretto NS. Spontaneous and reflex movements in brain death. Neurology. 2000;54(1):221-3.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | January 15, 2024 |
| Publication Date | January 1, 2024 |
| Submission Date | March 2, 2023 |
| Published in Issue | Year 2024 Volume: 10 Issue: 1 |
