Department of Neurology.
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Philadelphia, Pennsylvania, USA.
Curr Opin Pediatr. 2020 Dec;32(6):759-764. doi: 10.1097/MOP.0000000000000952.
Death by neurologic criteria (DNC) is the irreversible cessation of all functions of the entire brain, including the brainstem. It is legally recognized as equivalent to cardiopulmonary death. Legal and ethical controversies surrounding DNC have emerged as a result of several highly publicized cases that have eroded public trust in our ability to declare DNC accurately. In this review, we focus on recently published primary data about DNC and address some of these controversies.
Approximately 21% of children who die in pediatric intensive care units (PICU) are declared DNC. Although 60% of physicians report that they have been asked to maintain organ support after DNC declaration, less than 1% of patients remain physically present in the PICU more than 5 days after DNC declaration. We discuss strategies for safely conducting the apnea test, indications and prevalence of ancillary testing, and objections to DNC, including issues of consent and requests for ongoing organ support.
In order to maintain public trust, published guidelines must be followed to accurately and consistently diagnose DNC. We must develop strategies to respond to objections to DNC determination. Ongoing research is needed to improve the safety of apnea testing and indications for and interpretation of ancillary testing.
根据神经学标准判定的死亡（DNC）是整个大脑（包括脑干）所有功能的不可逆转停止。它在法律上被视为等同于心肺死亡。由于几起备受瞩目的案例引发了围绕 DNC 的法律和伦理争议，这些案例削弱了公众对我们准确判定 DNC 的能力的信任。在本次综述中，我们重点关注了最近发表的有关 DNC 的原始数据，并探讨了其中的一些争议。
在儿科重症监护病房（PICU）死亡的儿童中，约有 21%被判定为 DNC。尽管 60%的医生报告说他们被要求在 DNC 宣布后维持器官支持，但在 DNC 宣布后超过 5 天，仍有不到 1%的患者在 PICU 中实际存在。我们讨论了安全进行呼吸暂停试验的策略、辅助检查的适应证和发生率，以及对 DNC 的反对意见，包括同意问题和对持续器官支持的要求。
为了维护公众的信任，必须遵循已发布的指南来准确、一致地诊断 DNC。我们必须制定策略来应对对 DNC 判定的反对意见。需要开展进一步的研究来提高呼吸暂停试验的安全性以及辅助检查的适应证和解读。
