Shewmon D Alan
1 David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
J Child Neurol. 2017 Dec;32(14):1104-1117. doi: 10.1177/0883073817736961.
A 2-year-old boy with severe head trauma was diagnosed brain dead according to the 2011 Pediatric Guidelines. Computed tomographic (CT) scan showed massive cerebral edema with herniation. Intracranial pressures were extremely high, with cerebral perfusion pressures around 0 for several hours. An apnea test was initially contraindicated; later, one had to be terminated due to oxygen desaturation when the Pco had risen to 57.9 mm Hg. An electroencephalogram (EEG) was probably isoelectric but formally interpreted as equivocal. Tc-99m diethylene-triamine-pentaacetate (DTPA) scintigraphy showed no intracranial blood flow, so brain death was declared. Parents declined organ donation. A few minutes after withdrawal of support, the boy began to breathe spontaneously, so the ventilator was immediately reconnected and the death declaration rescinded. Two hours later, life support was again removed, this time for prognostic reasons; he did not breathe, and death was declared on circulatory-respiratory grounds. Implications regarding the specificity of the guidelines are discussed.
一名2岁重度颅脑外伤男孩根据2011年儿科指南被诊断为脑死亡。计算机断层扫描（CT）显示大量脑水肿伴脑疝形成。颅内压极高，脑灌注压在数小时内接近0。最初，呼吸暂停试验被列为禁忌；后来，当二氧化碳分压升至57.9 mmHg时，由于氧饱和度下降，试验不得不终止。脑电图（EEG）可能呈等电位，但正式解读为不明确。锝-99m二乙三胺五乙酸（DTPA）闪烁扫描显示颅内无血流，因此宣布脑死亡。父母拒绝器官捐献。撤除支持措施几分钟后，男孩开始自主呼吸，于是立即重新连接呼吸机并撤销死亡宣告。两小时后，出于预后原因再次撤除生命支持；他没有呼吸，最终基于循环呼吸原因宣布死亡。文中讨论了该指南特异性的相关问题。
