Bodí M A, Pont T, Sandiumenge A, Oliver E, Gener J, Badía M, Mestre J, Muñoz E, Esquirol X, Llauradó M, Twose J, Quintana S
Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut Investigació Sanitària Pere Virgili, Tarragona, España.
Coordinación de Trasplantes, Hospital Universitario Vall d'Hebrón, Barcelona, España.
Med Intensiva. 2015 Aug-Sep;39(6):337-44. doi: 10.1016/j.medin.2014.07.010. Epub 2014 Oct 23.
To analyze the profile, incidence of life support therapy limitation (LSTL) and donation potential in neurocritical patients.
A multicenter prospective study was carried out.
Nine hospitals authorized for organ harvesting for transplantation.
All patients consecutively admitted to the hospital with GCS < 8 during a 6-month period were followed-up until discharge or day 30 of hospital stay.
Demographic data, cause of coma, clinical status upon admission and outcome were analyzed. LSTL, brain death (BD) and organ donation incidence were recorded.
A total of 549 patients were included, with a mean age of 59.0 ± 14.5 years. The cause of coma was cerebral hemorrhage in 27.0% of the cases.LSTL was applied in 176 patients (32.1%). In 78 cases LSTL consisted of avoiding ICU admission. Age, the presence of contraindications, and specific causes of coma were associated to LSTL. A total of 58.1% of the patients died (n=319). One-hundred and thirty-three developed BD (24.2%), and 56.4% of these became organ donors (n=75). The presence of edema and mid-line shift on the CT scan, and transplant coordinator evaluation were associated to BD. LSTL was associated to a no-BD outcome. Early LSTL (first 4 days) was applied in 9 patients under 80 years of age, with no medical contraindications for donation and a GCS ≤ 4 who finally died in asystole.
LSTL is a frequent practice in neurocritical patients. In almost one-half of the cases, LSTL consisted of avoiding admission to the ICU, and on several occasions the donation potential was not evaluated by the transplant coordinator.
分析神经重症患者的概况、生命支持治疗限制（LSTL）发生率及捐献潜力。
开展一项多中心前瞻性研究。
九家获授权进行器官获取用于移植的医院。
在6个月期间连续入院且格拉斯哥昏迷量表（GCS）评分<8分的所有患者均随访至出院或住院第30天。
分析人口统计学数据、昏迷原因、入院时临床状况及结局。记录LSTL、脑死亡（BD）及器官捐献发生率。
共纳入549例患者，平均年龄59.0±14.5岁。27.0%的病例昏迷原因是脑出血。176例患者（32.1%）应用了LSTL。78例患者的LSTL包括避免入住重症监护病房（ICU）。年龄、存在的禁忌证及昏迷的特定原因与LSTL相关。共有58.1%的患者死亡（n = 319）。133例患者发生脑死亡（24.2%），其中56.4%成为器官捐献者（n = 75）。CT扫描显示存在水肿和中线移位以及移植协调员的评估与脑死亡相关。LSTL与未发生脑死亡的结局相关。9例80岁以下患者在无捐献医学禁忌证且GCS≤4分的情况下在入院后前4天应用了早期LSTL，这些患者最终死于心搏停止。
LSTL在神经重症患者中是一种常见做法。在近一半的病例中，LSTL包括避免入住ICU，并且在某些情况下移植协调员未评估捐献潜力。
