Brain death: practicability of evoked potentials

Relationships Between Resting Energy Expenditure and Transcranial Doppler Measurements in Patients With and Without Brain Death

Introduction Brain metabolism deteriorates during brain death, suggesting that cerebral metabolic measurements could serve as a prognostic factor. The application of transcranial Doppler can be useful in evaluating patients evolving to brain death. Resting energy expenditure is lower than expected in patients with brain death, and this is caused by the decrease in cerebral blood flow and consequently lower oxygen supply. The primary aim of this retrospective study is to investigate the early metabolic changes in patients with clinical criteria of brain death and examine if these changes are related to a gradual decrease in blood flow velocities in the middle cerebral artery. Methods All consecutive patients from 1st June 2018 to 30th April 2022, admitted to the ICU with brain injury and a GCS ≤ 8, were included retrospectively in the study. Patients were allocated into two groups: Group A, patients without clinical signs of brain death (n = 32), and Group B, patients with brain death (n = 34). In each group, three sets of metabolic measurements were performed concomitantly with cerebral blood flow velocities using transcranial Doppler (a) upon admission to the ICU, (b) once hemodynamic stabilization was obtained, and (c) 48 hours after their hemodynamic stabilization or when brain death was confirmed by clinical criteria. Resting energy expenditure (REE) measurements were performed using a metabolic computer. Cerebral blood flow velocities were measured after a period of 30 min using a 2-MHZ 2D ultrasound probe. Results Brain-dead patients had a significant decrease in their metabolic parameters as the cerebral blood flow velocities recorded with the transcranial Doppler deteriorated, (REE Group A = 1667.65 ± 597 vs Group B = 1376.12 ± 615, p = 0.05 and REE predicted Group A = 113.19 ± 44.9 vs Group B = 93.29 ± 41.5, p = 0.066 for measurement 1; REE Group A = 1844 ± 530.9 vs Group B = 1219.97 ± 489, p < 0.001 and REE predicted Group A = 124.38 ± 39 vs Group B = 81.35 ± 30.4, p < 0.001 for measurement 2; REE Group A = 1750.97 ± 414, p < 0.001 and REE predicted Group A = 116.38 ± 19.2 vs Group B = 56.09 ± 19.6, p < 0.001 for measurement 3). Multiple stepwise regression analysis revealed a strong relationship between age, the worsening of the blood flow velocities pattern, and the decrease in REE (multiple R = 0.264, F = 5.55, p = 0.009). Furthermore, a statistically significant correlation was found between temperature and REE (correlation coefficient = 0.500, 0.674, 0.784 for measurements 1, 2, and 3, respectively, and p < 0.001 for all measures). Conclusions In brain-dead patients, the gradual decrease in cerebral blood flow leads to a decrease in REE as well as thermogenetic control. These changes can be detected early after the patient's admission to the ICU.

Comparison of Methods for Individual Killing of Broiler Chickens: A Matter of Animal Welfare and On-Farm Feasibility

The humane killing of individual broiler chickens on-farm requires a minimum of suffering. In this regard, rapid and irreversible loss of consciousness are important determinants. This can be verified by cerebral and spinal reflexes. Also, on-farm feasibility determines whether producers will apply the method. The aim of the study was to compare the effectiveness and animal welfare impact of two different methods for killing individual broilers of varying ages (2, 4, and 6 weeks): manual cervical dislocation (CD) and captive bolt (CB). The evaluation of CD and CB was based on effectiveness and on time to onset (convulsions) or cessation (pain response, pupillary light reflex, convulsions, heartbeat) of non-invasive indicators. In addition, a pilot study was conducted on-farm to assess the feasibility of two alternative methods, CB and nitrogen gasification (N2), and to survey farmers’ opinions on them. The onset of convulsions was almost immediate for both methods in the first study. No differences between CD and CB were observed for the cessation of pain response for chickens at age of 2 weeks (5.0 and 7.5 s, respectively) and 6 weeks (14.0 and 14.1 s, respectively). However, at 4 weeks a longer pain response was measured after CD (11.3 s) than after CB (4.7 s). For the three age categories, the pupillary light reflex disappeared later after CD (54.9 - 80.7 s) compared to CB (8.3 - 13.7 s). The same was observed for cessation of convulsions in 2- and 6-week-old chickens (185.3 and 172.0 s for CD and 79.0 and 82.9 s for CB). This suggests that brain death occurred faster after CB compared to CD. No difference between the methods was found for the cessation of the heartbeat. After the pilot study, the producers preferred N2 over CB in terms of animal-friendliness, time-efficiency, ease of use, and effectiveness. However, both methods were found rather expensive and required some experience. CB and N2 are good killing alternatives to CD due to rapid and irreversible insensibility. However, more information and support for chicken producers will be needed for these to become routine killing methods.