Department of Anesthesiology and Reanimation, Van Yüzüncü Yıl University, School of Medicine, Van, Turkey.
Department of Anesthesiology and Reanimation, Van Yüzüncü Yıl University, School of Medicine, Van, Turkey.
Transplant Proc. 2021 Mar;53(2):596-601. doi: 10.1016/j.transproceed.2020.08.021. Epub 2020 Sep 19.
The diagnosis of brain death (BD) is mainly a clinical diagnosis. Ancillary tests may be used in confusing situations. Although computed tomography angiography (CTA) has high sensitivity and specificity, it can give false-positive results in cases with craniotomy.
The aim of this study is to emphasize the importance of accurate and detailed clinical diagnosis and to reveal that there is organ loss as a result of prolonged supportive tests, especially in developing countries.
This retrospective study included patients who were diagnosed with BD in the intensive care unit of Van Yüzüncü Yıl University, between September 2014 and August 2017 in Turkey. The study included 14 male and 8 female patients. Patients who did not show any spontaneous respiratory symptoms after the apnea test were diagnosed with clinical BD. Patients on neurodepressant medications who were hypothermic or hypoxic or had a severe endocrine or metabolic disorder were excluded from the study. CTA was used as an ancillary test in compliance with legal requirements. Age, sex, hospitalization days, day of clinical diagnosis of BD, first radiologic evaluation by CTA, clinical diagnosis, and radiologic evaluation were recorded for all patients.
Radiologic evaluation was not compatible with the clinical evaluation in 5 patients. Although 2 of these 5 patients had BD diagnosis clinically, blood flow could be expected during CTA because of cranial injury. Unlike in the literature, false positivity was found in 3 patients with hypoxic ischemic encephalopathy in the present study.
Proper management of limited resources and the facilitation of cadaver organ donation in developing countries are important and humanitarian global responsibilities. Revision of the country's legal regulations is important and is warranted in this regard.
脑死亡（BD）的诊断主要是临床诊断。在情况复杂时，可以使用辅助检查。虽然计算机断层血管造影（CTA）具有很高的灵敏度和特异性，但在开颅术后可能会出现假阳性结果。
本研究旨在强调准确和详细的临床诊断的重要性，并揭示由于延长支持性检查而导致器官丧失的情况，尤其是在发展中国家。
本回顾性研究纳入了 2014 年 9 月至 2017 年 8 月在土耳其凡大学附属医院重症监护病房被诊断为 BD 的患者。研究共纳入 14 名男性和 8 名女性患者。在窒息试验后无任何自主呼吸症状的患者被诊断为临床 BD。排除接受神经抑制剂治疗且体温过低或缺氧或存在严重内分泌或代谢紊乱的患者。按照法律要求，将 CTA 作为辅助检查。记录所有患者的年龄、性别、住院天数、BD 临床诊断日、首次 CTA 放射学评估、临床诊断和放射学评估。
5 名患者的放射学评估与临床评估不符。尽管这 5 名患者中有 2 名在临床上被诊断为 BD，但由于颅骨损伤，CTA 期间可能会有血流。与文献不同，本研究中 3 名患有缺氧缺血性脑病的患者出现了假阳性。
在发展中国家，对有限资源进行妥善管理并促进尸体器官捐献是重要的人道主义全球责任。在这方面，修订国家法律法规很重要。
