Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Hong Kong.
Hong Kong Med J. 2020 Apr;26(2):120-126. doi: 10.12809/hkmj198126. Epub 2020 Apr 14.
Among patients in paediatric intensive care units (PICUs), death is sometimes inevitable despite advances in treatment. Some PICU patients may have irreversible cessation of all brain function, which is considered as brain death (BD). This study investigated demographic and clinical differences between PICU patients with BD and those with cardiopulmonary death.
All children who died in the PICU at a university-affiliated trauma centre between October 2002 and October 2018 were included in this retrospective study. Demographics and clinical characteristics were compared between patients with BD and patients with cardiopulmonary death.
Of the 2784 patients admitted to the PICU during the study period, 127 died (4.6%). Of these 127 deaths, 22 (17.3%) were BD and 105 were cardiopulmonary death. Length of PICU stay was shorter for patients with cardiopulmonary death than for patients with BD (2 vs 8.5 days, P=0.0042). The most common mechanisms of injury in patients with BD were hypoxic-ischaemic injury (40.9%), central nervous system infection (18.2%), and traumatic brain injury (13.6%). The combined proportion of accident and trauma-related injury was greater in patients with BD than in patients with cardiopulmonary death (27.3% vs 3.8%, P<0.001). Organ donation was approved by the families of four of the 22 patients with BD (18.2%) and was performed successfully in three of these four patients.
These findings emphasise the importance of injury prevention in childhood, as well as the need for education of the public regarding acceptance of BD and support for organ donation.
在儿科重症监护病房（PICU）的患者中，尽管治疗有所进步，但有时死亡仍不可避免。一些 PICU 患者可能会出现所有脑功能不可逆转的停止，这被认为是脑死亡（BD）。本研究调查了 BD 患者和心肺死亡患者在人口统计学和临床方面的差异。
本回顾性研究纳入了 2002 年 10 月至 2018 年 10 月期间在一所大学附属创伤中心 PICU 死亡的所有儿童。比较了 BD 患者和心肺死亡患者的人口统计学和临床特征。
在研究期间，共有 2784 名患者入住 PICU，其中 127 人死亡（4.6%）。在这 127 例死亡中，22 例（17.3%）为 BD，105 例为心肺死亡。与 BD 患者相比，心肺死亡患者的 PICU 住院时间更短（2 天 vs 8.5 天，P=0.0042）。BD 患者最常见的损伤机制是缺氧缺血性损伤（40.9%）、中枢神经系统感染（18.2%）和创伤性脑损伤（13.6%）。BD 患者的意外和创伤相关损伤的综合比例高于心肺死亡患者（27.3% vs 3.8%，P<0.001）。BD 患者的家属中有 4 人（18.2%）同意器官捐献，其中 3 人成功捐献。
这些发现强调了儿童时期预防伤害的重要性，以及公众对 BD 的接受和支持器官捐献的教育的必要性。
