南澳大利亚重症监护病房中使用影像学检查确定脑死亡

Use of imaging studies for determination of brain death in South Australian intensive care units.

作者信息

Sampson Brett G, Datson Luke D, Bihari Shailesh

机构信息

Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, SA, Australia.

出版信息

Crit Care Resusc. 2017 Mar;19(1):57-63.

PMID:28215133

Abstract

OBJECTIVES

To describe the use of imaging studies (four-vessel angiography or radionuclide scan) for brain death determination in South Australian intensive care units, and to determine the rates of adherence with The ANZICS statement on death and organ donation of the Australian and New Zealand Intensive Care Society (ANZICS).

DESIGN, PATIENTS AND SETTING: Retrospective case-note review of 190 South Australian adult patients (≥ 18 years) who were brain dead and were organ donors (actual and intended), from 1 January 2008 to 31 December 2014.

MAIN OUTCOME MEASURES

We compared brain death determination by clinical examination and by imaging, and identified, using logistic regression, the independent predictors of brain death determination by imaging (and for imaging without a documented indication).

RESULTS

Brain death determination by imaging occurred for 79 patients who were brain-dead donors (41.6%), with a documented indication in only 38 patients (48.1%), of whom 35 had an indication which adhered to ANZICS recommendations. The group who had brain death determined by imaging were younger (P < 0.001), with a higher proportion of hypoxic brain injury (P = 0.01) and therapeutic hypothermia (P = 0.02). Independent predictors of brain death determination by imaging were female sex (Β = 3.101, P = 0.03), age (Β = 0.964, P = 0.01), brain death determination between 5 pm and 8 am (Β = 0.332, P = 0.04), cause of death (Β = 1.833, P = 0.04), therapeutic hypothermia (Β = 0.162, P = 0.04) and terminal serum sodium level ≥ 150 mmol/L (Β = 0.131, P = 0.005); Nagelkerke R = 0.669. Hypoxia was the only independent predictor of imaging without a documented ANZICS indication (Β = 0.071, P = 0.032; Nagelkerke R = 0.581).

CONCLUSIONS

Therapeutic hypothermia, terminal serum sodium level ≥ 150 mmol/L and cause of death were independent predictors of brain death determination by imaging study. Documentation of imaging indication was poor, particularly after hypoxic brain injury. This may reflect emerging indications for imaging, poor adherence to ANZICS recommendations, or simple omissions.

摘要

目的

描述在南澳大利亚重症监护病房中使用影像学检查（四血管造影或放射性核素扫描）来判定脑死亡的情况，并确定澳大利亚和新西兰重症监护学会（ANZICS）关于死亡和器官捐献的声明的遵守率。

设计、患者与研究背景：对2008年1月1日至2014年12月31日期间南澳大利亚190名成年（≥18岁）脑死亡且为器官捐献者（实际和意向）的患者进行回顾性病例记录审查。

主要观察指标

我们比较了通过临床检查和影像学检查判定脑死亡的情况，并使用逻辑回归确定了通过影像学检查判定脑死亡的独立预测因素（以及针对无记录指征的影像学检查）。

结果

79名脑死亡捐献者（41.6%）通过影像学检查判定脑死亡，其中仅有38名患者（48.1%）有记录的指征，其中35名的指征符合ANZICS建议。通过影像学检查判定脑死亡的患者群体更年轻（P<0.001），缺氧性脑损伤比例更高（P = 0.01），且接受治疗性低温的比例更高（P = 0.02）。通过影像学检查判定脑死亡的独立预测因素为女性（β = 3.101，P = 0.03）、年龄（β = 0.964，P = 0.01）、下午5点至上午8点之间判定脑死亡（β = 0.332，P = 0.04）、死亡原因（β = 1.833，P = 0.04）、治疗性低温（β = 0.162，P = 0.04）以及终末期血清钠水平≥150 mmol/L（β = 0.131，P = 0.005）；Nagelkerke R = 0.669。缺氧是无记录的ANZICS指征的影像学检查的唯一独立预测因素（β = 0.071，P = 0.032；Nagelkerke R = 0.581）。