Pediatrics. 2011 Sep;128(3):e720-40. doi: 10.1542/peds.2011-1511. Epub 2011 Aug 28.
To review and revise the 1987 pediatric brain death guidelines.
Relevant literature was reviewed. Recommendations were developed using the GRADE system.
(1) Determination of brain death in term newborns, infants and children is a clinical diagnosis based on the absence of neurologic function with a known irreversible cause of coma. Because of insufficient data in the literature, recommendations for preterm infants less than 37 weeks gestational age are not included in this guideline. (2) Hypotension, hypothermia, and metabolic disturbances should be treated and corrected and medications that can interfere with the neurologic examination and apnea testing should be discontinued allowing for adequate clearance before proceeding with these evaluations. (3) Two examinations including apnea testing with each examination separated by an observation period are required. Examinations should be performed by different attending physicians. Apnea testing may be performed by the same physician. An observation period of 24 hours for term newborns (37 weeks gestational age) to 30 days of age, and 12 hours for infants and chi (> 30 days to 18 years) is recommended. The first examination determines the child has met the accepted neurologic examination criteria for brain death. The second examination confirms brain death based on an unchanged and irreversible condition. Assessment of neurologic function following cardiopulmonary resuscitation or other severe acute brain injuries should be deferred for 24 hours or longer if there are concerns or inconsistencies in the examination. (4) Apnea testing to support the diagnosis of brain death must be performed safely and requires documentation of an arterial Paco(2) 20 mm Hg above the baseline and ≥ 60 mm Hg with no respiratory effort during the testing period. If the apnea test cannot be safely completed, an ancillary study should be performed. (5) Ancillary studies (electroencephalogram and radionuclide cerebral blood flow) are not required to establish brain death and are not a substitute for the neurologic examination. Ancillary studies may be us d to assist the clinician in making the diagnosis of brain death (i) when components of the examination or apnea testing cannot be completed safely due to the underlying medical condition of the patient; (ii) if there is uncertainty about the results of the neurologic examination; (iii) if a medication effect may be present; or (iv) to reduce the inter-examination observation period. When ancillary studies are used, a second clinical examination and apnea test should be performed and components that can be completed must remain consistent with brain death. In this instance the observation interval may be shortened and the second neurologic examination and apnea test (or all components that are able to be completed safely) can be performed at any time thereafter. (6) Death is declared when the above criteria are fulfilled.
审查和修订 1987 年儿科脑死亡指南。
回顾相关文献。使用 GRADE 系统制定建议。
（1）足月新生儿、婴儿和儿童的脑死亡判定是基于已知昏迷不可逆转病因的无神经功能的临床诊断。由于文献中数据不足，本指南不包括胎龄<37 周的早产儿的建议。（2）低血压、低体温和代谢紊乱应得到治疗和纠正，可干扰神经检查和窒息试验的药物应停用，以便在进行这些评估前充分清除。（3）需要进行两次检查，每次检查均进行窒息试验，两次检查之间间隔观察期。检查应由不同的主治医生进行。窒息试验可以由同一位医生进行。建议足月新生儿（胎龄 37 周）至 30 天龄的观察期为 24 小时，婴儿和儿童（>30 天至 18 岁）的观察期为 12 小时。第一次检查确定患儿符合脑死亡的可接受神经检查标准。第二次检查基于不变且不可逆转的状态确认脑死亡。心肺复苏或其他严重急性脑损伤后，若检查存在疑问或不一致，应延迟 24 小时或更长时间进行神经功能评估。（4）支持脑死亡诊断的窒息试验必须安全进行，并需要记录动脉 Paco（2）比基线高 20mmHg 且在试验期间无呼吸努力。如果不能安全完成窒息试验，应进行辅助研究。（5）辅助研究（脑电图和放射性核素脑血流）不是诊断脑死亡所必需的，也不能替代神经检查。辅助研究可用于协助临床医生做出脑死亡诊断（i）由于患者的基础疾病，检查或窒息试验的某些部分无法安全完成；（ii）神经检查结果不确定时；（iii）可能存在药物作用时；或（iv）减少两次检查之间的观察期。当使用辅助研究时，应进行第二次临床检查和窒息试验，且必须完成与脑死亡一致的检查部分。在这种情况下，可以缩短观察间隔，且第二次神经检查和窒息试验（或可安全完成的所有检查部分）可在之后的任何时间进行。（6）满足上述标准即可宣布死亡。
