Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.
Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
J Intensive Care Med. 2020 Feb;35(2):203-207. doi: 10.1177/0885066617738714. Epub 2017 Oct 30.
To evaluate the accuracy of the imminent brain death (IBD) diagnosis in predicting brain death (BD) by daily assessment of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale (GCS) with the assessment of brain stem reflexes.
Prospective multicenter pilot study carried out in 5 adult Italian intensive care units (ICUs). Imminent brain death was established when the FOUR score was 0 (IBD-FOUR) or the GCS score was 3 and at least 3 among pupillary light, corneal, pharyngeal, carinal, oculovestibular, and trigeminal reflexes were absent (IBD-GCS).
A total of 219 neurologic evaluations were performed in 40 patients with deep coma at ICU admission (median GCS 3). Twenty-six had a diagnosis of IBD-FOUR, 27 of IBD-GCS, 14 were declared BD, and 9 were organ donors. The mean interval between IBD diagnosis and BD was 1.7 days (standard deviation [SD] 2.0 days) using IBD-FOUR and 2.0 days (SD 1.96 days) using IBD-GCS. Both FOUR and GCS had 100% sensitivity and low specificity (FOUR: 53.8%; GCS: 50.0%) in predicting BD.
Daily IBD evaluation in the ICU is feasible using FOUR and GCS with the assessment of brain stem reflexes. Both scales had 100% sensitivity in predicting IBD, but FOUR may be preferable since it incorporates the pupillary, corneal, and cough reflexes and spontaneous breathing that are easily assessed in the ICU.
通过每日评估昏迷程度全面反应量表（FOUR）评分和格拉斯哥昏迷量表（GCS）与脑干反射评估，评估即将发生的脑死亡（IBD）诊断对脑死亡（BD）的诊断准确性。
这是一项在意大利 5 家成人重症监护病房（ICU）进行的前瞻性多中心试点研究。当 FOUR 评分为 0 时（IBD-FOUR）或 GCS 评分为 3 分且瞳孔光反射、角膜反射、咽反射、隆突反射、眼前庭反射和三叉神经反射中至少有 3 项缺失时（IBD-GCS），即可确立即将发生的脑死亡。
40 名入住 ICU 时深度昏迷的患者共进行了 219 次神经评估（中位 GCS 为 3）。26 例患者被诊断为 IBD-FOUR，27 例患者被诊断为 IBD-GCS，14 例患者被确诊为 BD，9 例患者为器官捐献者。使用 IBD-FOUR 诊断 IBD 与确诊 BD 的平均间隔为 1.7 天（标准差 [SD] 2.0 天），使用 IBD-GCS 诊断 IBD 与确诊 BD 的平均间隔为 2.0 天（SD 1.96 天）。FOUR 和 GCS 预测 BD 的敏感性均为 100%，特异性较低（FOUR：53.8%；GCS：50.0%）。
在 ICU 中使用 FOUR 和 GCS 并评估脑干反射进行每日 IBD 评估是可行的。两种量表在预测 IBD 方面均具有 100%的敏感性，但 FOUR 可能更优，因为它包含了瞳孔、角膜和咳嗽反射以及在 ICU 中容易评估的自主呼吸。
