Yener Nazik, Paksu Muhammed Şükrü, Köksoy Özlem
Ondokuz Mayıs University School of Medicine, Division of Pediatric Critical Care, Samsun, Turkey.
J Crit Care Med (Targu Mures). 2018 Feb 9;4(1):12-16. doi: 10.1515/jccm-2018-0005. eCollection 2018 Jan.
Brain death is currently defined as the loss of full brain function including the brainstem. The diagnosis and its subsequent management in the pediatric population are still controversial. The aim of this study was to define the demographic characteristics, clinical features and outcomes of patients with brain death and determine the incidence of brain death, donation rates and occurrence of central diabetes insipidus accompanying brain death in children.
This retrospective study was conducted at a twelve-bed tertiary-care combined medical and surgical pediatric intensive care unit of the Ondokuz Mayis University Medical School, Samsun, Turkey. In 37 of 341 deaths (10.8%), a diagnosis of brain death was identified. The primary insult causing brain death was post-cardiorespiratory arrest in 8 (21.6%), head trauma in 8 (21.6%), and drowning in 4 (18.9%). In all patients, transcranial Doppler ultrasound was utilised as an ancillary test and test was repeated until it was consistent with brain death.
In 33 (89%) patients, central diabetes insipidus was determined at or near the time brain death was confirmed. The four patients not diagnosed with CDI had acute renal failure, and renal replacement treatment was carried out. The consent rate for organ donation was 18.9%, and 16.7% of potential donors proceeded to actual donation.
In the current study the consent rate for organ donation is relatively low compared to the rest of the world. The prevalence of central diabetes insipidus in this pedaitric brain death population is higher than reports in the literature, and acute renal failure accounted for the lack of central diabetes insipidus in four patients with brain death. Further studies are needed to explain normouria in brain-dead patients.
目前，脑死亡被定义为包括脑干在内的全脑功能丧失。其在儿科人群中的诊断及后续处理仍存在争议。本研究的目的是明确脑死亡患者的人口统计学特征、临床特征及预后，并确定儿童脑死亡的发生率、捐赠率以及脑死亡伴随的中枢性尿崩症的发生率。
本回顾性研究在土耳其萨姆松市翁多库兹迈伊斯大学医学院拥有12张床位的儿科综合医疗与外科重症监护病房进行。在341例死亡病例中，有37例（10.8%）被诊断为脑死亡。导致脑死亡的主要病因包括心脏骤停后8例（21.6%）、头部外伤8例（21.6%）、溺水4例（18.9%）。所有患者均采用经颅多普勒超声作为辅助检查，且该检查会重复进行直至与脑死亡情况相符。
在33例（89%）患者中，在确认脑死亡时或接近该时间点确定存在中枢性尿崩症。未被诊断为中枢性尿崩症的4例患者患有急性肾衰竭，并接受了肾脏替代治疗。器官捐赠的同意率为18.9%，16.7%的潜在捐赠者进行了实际捐赠。
在本研究中，与世界其他地区相比，器官捐赠的同意率相对较低。该儿科脑死亡人群中中枢性尿崩症的患病率高于文献报道，急性肾衰竭是4例脑死亡患者未出现中枢性尿崩症的原因。需要进一步研究来解释脑死亡患者的正常尿量情况。
