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Bolt B, Muakkassa F, Bruening L, Marcus C, Cunningham B, Pawlak E, Gandee R, Newey C. Cardiac Oscillations Complicating Brain Death Diagnosis. Case Rep Crit Care 2023; 2023:1132406. [PMID: 37727825 PMCID: PMC10506872 DOI: 10.1155/2023/1132406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/24/2023] [Accepted: 07/15/2023] [Indexed: 09/21/2023] Open
Abstract
Death by neurologic criteria (DNC) or brain death is a clinical diagnosis. It is often complicated by variations in policies as well as confounders on examination. We discuss here the case of a 27-year-old male who had a cardiac arrest following toxic gaseous exposure. He ultimately progressed to brain death but was identified as having cardiac oscillations during clinical assessments that complicated the diagnosis. We discuss the case as well as the maneuvers used to clarify that the "triggered breaths" on the ventilator were indeed cardiac oscillations.
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Affiliation(s)
- Brittany Bolt
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Farid Muakkassa
- Section of Trauma, Cleveland Clinic Akron General Hospital, Akron, Ohio, USA
| | - Lindsay Bruening
- Section of Neurology, Cleveland Clinic Akron General Hospital, Akron, Ohio, USA
| | - Cameron Marcus
- Section of Emergency Medicine, Cleveland Clinic Akron General Hospital, Akron, Ohio, USA
| | - Brittany Cunningham
- Section of Pharmacy, Cleveland Clinic Akron General Hospital, Akron, Ohio, USA
| | - Erin Pawlak
- Section of Neurology, Cleveland Clinic Akron General Hospital, Akron, Ohio, USA
| | - Richard Gandee
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Section of Neurology, Cleveland Clinic Akron General Hospital, Akron, Ohio, USA
| | - Christopher Newey
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Department of Neurocritical Care and ICU-EEG, Sanford Health, Sioux Falls, OH, USA
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Alnajjar HA, Alzahrani M, Alzahrani M, Banweer M, Alsolami E, Alsulami A. Awareness of brain death, organ donation, and transplantation among medical students at single academic institute. Saudi J Anaesth 2020; 14:329-334. [PMID: 32934625 PMCID: PMC7458020 DOI: 10.4103/sja.sja_765_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/31/2020] [Accepted: 01/16/2020] [Indexed: 11/19/2022] Open
Abstract
Objective: To assess the knowledge of the concept of brain death, attitude, and level of awareness towards organ donation and transplantation, among medical students and interns at the University of Jeddah, Kingdom of Saudi Arabia. Methods: A cross-sectional study via electronic questionnaire over period of 3 weeks to 2nd through 6th year medical students and interns at university of Jeddah. Results: A response rate of 113 out of 151 (74.83%) was achieved. Among participants, 36% expressed uncertainty when questioned about the concept of brain death. 8.8% of the participants were against the idea of organ donation. 60% of those who refused to contemplate organ donation were unfamiliar with the brain death concept. No significant difference was seen regarding fears about cosmetic disfiguration between those familiar and unfamiliar with the concept of brain death. 60.2% of the study cohort would consider donating their organs to family members but only 29.2% of them had discussed the matter of organ donation and transplantation with them, while 44.2% had discussed the matter with their friends. Majority of medical students (71.7%) were interested in being organ donors. Conclusion: Knowledge of organ donation and transplantation were adequate. Matter accepting brain death and its implication still not clear for most of participants. We believe there is still room to improve. This could be achieved by integrating more education about different aspects of brain death and its implications through medical school years.
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Affiliation(s)
- Hani A Alnajjar
- Department of Anesthesia, University of Jeddah, Hamzah Ibn Al Qasim Street, Al Sharafeyah, Jeddah, Saudi Arabia
| | - Maan Alzahrani
- Medical Student, University of Jeddah, Hamzah Ibn Al Qasim Street, Al Sharafeyah, Jeddah, Saudi Arabia
| | - Muath Alzahrani
- Medical Student, University of Jeddah, Hamzah Ibn Al Qasim Street, Al Sharafeyah, Jeddah, Saudi Arabia
| | - Mazen Banweer
- Medical Student, University of Jeddah, Hamzah Ibn Al Qasim Street, Al Sharafeyah, Jeddah, Saudi Arabia
| | - Essam Alsolami
- Medical Student, University of Jeddah, Hamzah Ibn Al Qasim Street, Al Sharafeyah, Jeddah, Saudi Arabia
| | - Azzam Alsulami
- Medical Student, University of Jeddah, Hamzah Ibn Al Qasim Street, Al Sharafeyah, Jeddah, Saudi Arabia
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Schwartz MR, Pukenas EW. Organ Harvesting and the Role of Anesthesiologist. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Souter MJ, Eidbo E, Findlay JY, Lebovitz DJ, Moguilevitch M, Neidlinger NA, Wagener G, Paramesh AS, Niemann CU, Roberts PR, Pretto EA. Organ Donor Management: Part 1. Toward a Consensus to Guide Anesthesia Services During Donation After Brain Death. Semin Cardiothorac Vasc Anesth 2017; 22:211-222. [PMID: 29276852 DOI: 10.1177/1089253217749053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Worldwide 715 482 patients have received a lifesaving organ transplant since 1988. During this time, there have been advances in donor management and in the perioperative care of the organ transplant recipient, resulting in marked improvements in long-term survival. Although the number of organs recovered has increased year after year, a greater demand has produced a critical organ shortage. The majority of organs are from deceased donors; however, some are not suitable for transplantation. Some of this loss is due to management of the donor. Improved donor care may increase the number of available organs and help close the existing gap in supply and demand. In order to address this concern, The Organ Donation and Transplantation Alliance, the Association of Organ Procurement Organizations, and the Transplant and Critical Care Committees of the American Society of Anesthesiologists have formulated evidence-based guidelines, which include a call for greater involvement and oversight by anesthesiologists and critical care specialists, as well as uniform reporting of data during organ procurement and recovery.
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Affiliation(s)
| | - E Eidbo
- 2 Association of Organ Procurement Organizations, Vienna, VA, USA
| | | | | | | | | | | | - Anil S Paramesh
- 8 Tulane University School of Medicine, New Orleans, LA, USA
| | - Claus U Niemann
- 9 University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Pamela R Roberts
- 10 University of Oklahoma Medical Center, Oklahoma City, OK, USA
| | - Ernesto A Pretto
- 11 University of Miami Miller School of Medicine, Miami, FL, USA
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Margo JA, Whiting MF, Brown CH, Hoover CK, Munir WM. The Effect of Chronic Pulmonary Disease and Mechanical Ventilation on Corneal Donor Endothelial Cell Density and Transplant Suitability. Am J Ophthalmol 2017; 183:65-70. [PMID: 28890079 DOI: 10.1016/j.ajo.2017.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine how chronic obstructive pulmonary disease (COPD) and mechanical ventilation time affect corneal donor endothelial cell density (ECD) and transplant suitability. DESIGN Retrospective cohort study. METHODS Setting: Institutional. STUDY POPULATION Total of 39 679 cornea donor eyes from SightLife Eye Bank between 2012 and 2016. Demographics, death-to-preservation time, ECD, lens status, medical history, time on mechanical ventilation, and suitability for transplantation were included. MAIN OUTCOME MEASURES ECD and transplant suitability. RESULTS Mean ECD was 2733 cells/mm2. Mean age was 59 years. COPD affected 34.2% of donors. Mechanical ventilation was required in 35% of donors. Mean ventilation time was 1.3 days. After controlling for covariates, COPD was not found to be associated with poor transplant suitability (P = .22). Ventilation >7 days was associated with poor transplant suitability (P = .04). Donors with COPD and donors who were mechanically ventilated exhibited lower cell counts (P < .001, P < .01, respectively). Longer ventilation led to reduced endothelial cell density: ventilation time >7 days (-46.5 cells/mm2, P < .001) and >30 days (-101.4 cells/mm2, P = .02). Limitations of the study included the retrospective nature, dataset obtained from a single eye bank, and medical history documentation completed by eye bank technicians. CONCLUSIONS A high proportion of cornea donors have respiratory disease prior to donation. Ventilation time >7 days affected transplant suitability but the presence of COPD did not. Donors with COPD and donors who were mechanically ventilated had reduced cell counts. Longer ventilation times lead to increased cell loss. The presence of respiratory disease may affect tissue oxygenation and endothelial cell health.
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Keshtkaran Z, Sharif F, Navab E, Gholamzadeh S. Lived Experiences of Iranian Nurses Caring for Brain Death Organ Donor Patients: Caring as "Halo of Ambiguity and Doubt". Glob J Health Sci 2015; 8:281-92. [PMID: 26925919 PMCID: PMC4965685 DOI: 10.5539/gjhs.v8n7p281] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background: Brain death is a concept in which its criteria have been expressed as documentations in Harvard Committee of Brain Death. The various perceptions of caregiver nurses for brain death patients may have effect on the chance of converting potential donors into actual organ donors. Objective: The present study has been conducted in order to perceive the experiences of nurses in care-giving to the brain death of organ donor patients. Methods: This qualitative study was carried out by means of Heidegger’s hermeneutic phenomenology. Eight nurses who have been working in ICU were interviewed. The semi-structured interviews were recorded by a tape-recorder and the given texts were transcribed and the analyses were done by Van-Mannen methodology and (thematic) analysis. Results: One of the foremost themes extracted from this study included ‘Halo of ambiguity and doubt’ that comprised of two sub-themes of ‘having unreasonable hope’ and ‘Conservative acceptance of brain death’. The unreasonable hope included lack of trust (uncertainty) in diagnosis and verification of brain death, passing through denial wall, and avoidance from explicit and direct disclosure of brain death in patients’ family. In this investigation, the nurses were involved in a type of ambiguity and doubt in care-giving to the potentially brain death of organ donor patients, which were also evident in their interaction with patients’ family and for this reason, they did not definitely announce the brain death and so far they hoped for treatment of the given patient. Such confusion and hesitance both caused annoyance of nurses and strengthening the denial of patients’ family to be exposed to death. Conclusion: The results of this study reveal the fundamental perceived care-giving of brain death in organ donor patients and led to developing some strategies to improve care-giving and achievement in donation of the given organ and necessity for presentation of educational and supportive services for nurses might become more evident than ever.
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Jawoniyi OO, Gormley K. How critical care nurses' roles and education affect organ donation. ACTA ACUST UNITED AC 2015; 24:698-700. [DOI: 10.12968/bjon.2015.24.13.698] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - Kevin Gormley
- Senior Lecturer School of Nursing & Midwifery, Queen's University Belfast, Northern Ireland
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Smith JW, Ghazi CA, Cain BC, Hurt RT, Garrison RN, Matheson PJ. Direct Peritoneal Resuscitation Improves Inflammation, Liver Blood Flow, and Pulmonary Edema in a Rat Model of Acute Brain Death. J Am Coll Surg 2014; 219:79-87. [DOI: 10.1016/j.jamcollsurg.2014.03.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
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dos Reis FP, Gomes BHP, Pimenta LL, Etzel A. Brain death and tissue and organ transplantation: the understanding of medical students. Rev Bras Ter Intensiva 2014; 25:279-83. [PMID: 24553508 PMCID: PMC4031882 DOI: 10.5935/0103-507x.20130048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/19/2013] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the level of knowledge of medical students about transplantation and
brain death. Methods An anonymous self-administered questionnaire answered by medical students from the
first through the sixth year that was based on information from the
Associação Brasileira de Transplante de Órgãos e Tecidos, the
Registro Brasileiro de Transplantes and the resolution that
defines the criteria for brain death. Results Of the 677 medical students asked, 310 (45.8%) agreed to answer the questionnaire.
In total, 22 (7.0%) subjects were excluded. Of the students who participated,
41.3% reported having already attended a class on organ transplantation and 33% on
brain death; 9.7% felt able to diagnose brain death (p<0.01); only 66.8%
indicated the kidney as the most transplanted solid organ in Brazil. Conclusion The level of knowledge of medical students at this institution regarding brain
death and transplantation is limited, which may be the result of an inadequate
approach during medical school.
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Affiliation(s)
- Flávio Pola dos Reis
- Corresponding author: Flávio Pola dos Reis, Rua Antonio Lamas, 50 -
Ipiranga, Zip code: 04257-190 - São Paulo (SP), Brazil. E-mail:
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Abstract
When brain injury is refractory to aggressive management and is considered nonsurvivable, with loss of consciousness and brain stem reflexes, a brain death protocol may be initiated to determine death according to neurological criteria. Clinical evaluation typically entails 2 consecutive formal neurological examinations to document total loss of consciousness and absence of brain stem reflexes and then apnea testing to evaluate carbon dioxide unresponsiveness within the brain stem. Confounding factors such as use of therapeutic hypothermia, high-dose metabolic suppression, and movements associated with complex spinal reflexes, fasciculations, or cardiogenic ventilator autotriggering may delay initiation or completion of brain death protocols. Neurodiagnostic studies such as 4-vessel cerebral angiography can rapidly document absence of blood flow to the brain and decrease intervals between onset of terminal brain stem herniation and formal declaration of death by neurological criteria. Intracranial pathophysiology leading to brain death must be considered along with clinical assessment, patterns of vital signs, and relevant diagnostic studies.
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Affiliation(s)
- Richard B. Arbour
- Richard B. Arbour is a liver transplant coordinator at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania
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12
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Early metabolic/cellular-level resuscitation following terminal brain stem herniation: implications for organ transplantation. AACN Adv Crit Care 2013; 24:59-78. [PMID: 23343814 DOI: 10.1097/nci.0b013e31827e3031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with terminal brain stem herniation experience global physiological consequences and represent a challenging population in critical care practice as a result of multiple factors. The first factor is severe depression of consciousness, with resulting compromise in airway stability and lung ventilation. Second, with increasing severity of brain trauma, progressive brain edema, mass effect, herniation syndromes, and subsequent distortion/displacement of the brain stem follow. Third, with progression of intracranial pathophysiology to terminal brain stem herniation, multisystem consequences occur, including dysfunction of the hypothalamic-pituitary axis, depletion of stress hormones, and decreased thyroid hormone bioavailability as well as biphasic cardiovascular state. Cardiovascular dysfunction in phase 1 is a hyperdynamic and hypertensive state characterized by elevated systemic vascular resistance and cardiac contractility. Cardiovascular dysfunction in phase 2 is a hypotensive state characterized by decreased systemic vascular resistance and tissue perfusion. Rapid changes along the continuum of hyperperfusion versus hypoperfusion increase risk of end-organ damage, specifically pulmonary dysfunction from hemodynamic stress and high-flow states as well as ischemic changes consequent to low-flow states. A pronounced inflammatory state occurs, affecting pulmonary function and gas exchange and contributing to hemodynamic instability as a result of additional vasodilatation. Coagulopathy also occurs as a result of consumption of clotting factors as well as dilution of clotting factors and platelets consequent to aggressive crystalloid administration. Each consequence of terminal brain stem injury complicates clinical management within this patient demographic. In general, these multisystem consequences are managed with mechanism-based interventions within the context of caring for the donor's organs (liver, kidneys, heart, etc.) after death by neurological criteria. These processes begin far earlier in the continuum of injury, at the moment of terminal brain stem herniation. As such, aggressive, mechanism-based care, including hormonal replacement therapy, becomes clinically appropriate before formal brain death declaration to support cardiopulmonary stability following terminal brain stem herniation.
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Noujeim C, Bouakl I, El-Khatib M, Bou-Khalil P. Ventilator auto-cycling from cardiogenic oscillations: case report and review of literature. Nurs Crit Care 2013; 18:222-8. [PMID: 23968440 DOI: 10.1111/nicc.12029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/21/2013] [Accepted: 04/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Brain death is the total loss of all brain and brain stem functions, and its diagnosis is often confirmed by an apnoea test, which relies on disconnecting the patient from the ventilator. Auto-triggering or auto-cycling is defined as a ventilator being triggered in the absence of patient effort, intrinsic respiratory drive or inspiratory muscle activity. Ventilator auto-triggering could delay the diagnosis of brain death leading to unnecessary admission for the patient and false hopes of recovery for the family. METHODS We report a case of ventilator auto-triggering associated with cardiogenic oscillations in a female patient. RESULTS We confirmed the finding of ventilator auto-triggering by changing the patient's position and reassessing the triggering thresholds. Brain death was then confirmed by apnoea test. CONCLUSION This case is presented to arouse the awareness of the medical staff and nurses to this phenomenon, which can mimic an intrinsic respiratory effort in patients allegedly diagnosed with brain death. Along with this case report, we review the English language publications for similar cases.
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Affiliation(s)
- Carlos Noujeim
- Division of Pulmonary and Critical Care, Department of Medicine, Tannourine Governmental Hospital, Batroun, Lebanon
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14
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Arbour RB. Early Metabolic/Cellular-Level Resuscitation Following Terminal Brain Stem Herniation. AACN Adv Crit Care 2013. [DOI: 10.4037/nci.0b013e31827e3031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Patients with terminal brain stem herniation experience global physiological consequences and represent a challenging population in critical care practice as a result of multiple factors. The first factor is severe depression of consciousness, with resulting compromise in airway stability and lung ventilation. Second, with increasing severity of brain trauma, progressive brain edema, mass effect, herniation syndromes, and subsequent distortion/displacement of the brain stem follow. Third, with progression of intracranial pathophysiology to terminal brain stem herniation, multisystem consequences occur, including dysfunction of the hypothalamic-pituitary axis, depletion of stress hormones, and decreased thyroid hormone bioavailability as well as biphasic cardiovascular state. Cardiovascular dysfunction in phase 1 is a hyperdynamic and hypertensive state characterized by elevated systemic vascular resistance and cardiac contractility. Cardiovascular dysfunction in phase 2 is a hypotensive state characterized by decreased systemic vascular resistance and tissue perfusion. Rapid changes along the continuum of hyperperfusion versus hypoperfusion increase risk of end-organ damage, specifically pulmonary dysfunction from hemodynamic stress and high-flow states as well as ischemic changes consequent to low-flow states. A pronounced inflammatory state occurs, affecting pulmonary function and gas exchange and contributing to hemodynamic instability as a result of additional vasodilatation. Coagulopathy also occurs as a result of consumption of clotting factors as well as dilution of clotting factors and platelets consequent to aggressive crystalloid administration. Each consequence of terminal brain stem injury complicates clinical management within this patient demographic. In general, these multisystem consequences are managed with mechanism-based interventions within the context of caring for the donor’s organs (liver, kidneys, heart, etc.) after death by neurological criteria. These processes begin far earlier in the continuum of injury, at the moment of terminal brain stem herniation. As such, aggressive, mechanism-based care, including hormonal replacement therapy, becomes clinically appropriate before formal brain death declaration to support cardiopulmonary stability following terminal brain stem herniation.
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Affiliation(s)
- Richard B. Arbour
- Richard B. Arbour is Critical Care Clinical Nurse Specialist, Philadelphia, Pennsylvania, and Clinical Adjunct Faculty, La Salle University and Holy Family University, 5928 N 11th St, Philadelphia, PA 19141
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Monforte-Royo C, Roqué M. The organ donation process: a humanist perspective based on the experience of nursing care. Nurs Philos 2012; 13:295-301. [DOI: 10.1111/j.1466-769x.2012.00544.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arbour RB. Confounding factors in brain death: cardiogenic ventilator autotriggering and implications for organ transplantation. Intensive Crit Care Nurs 2012; 28:321-8. [PMID: 22516437 DOI: 10.1016/j.iccn.2012.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 03/03/2012] [Accepted: 03/14/2012] [Indexed: 11/26/2022]
Abstract
Brain death is characterised by a flaccid, areflexic neurological examination; fixed, dilated and midpoint pupils and total absence of intrinsic respiratory drive. A non-reversible clinical state or brain lesion must also be identified. Integral to brain death diagnosis is loss of respiratory drive. Following terminal brainstem herniation, a cardiovascular hyperdynamic state often occurs. This hyperdynamic state causes cyclical volume displacement within the chest in phase with the cardiac cycle, causing oscillations in gas flow patterns and may be reflected in ventilator airway pressure and flow waveforms. When these flow/pressure waveform oscillations meet or exceed ventilator flow or pressure trigger sensitivity, ventilator breaths may be triggered in the total absence of intrinsic respiratory drive. In a patient with no apparent neurological function who is still triggering ventilator breaths, detailed analysis of ventilator pressure/flow waveforms in context with neurological assessment findings can identify cardiac autotriggering in a brain-dead patient. Undetected, cardiogenic ventilator autotriggering results in prolonged ICU stay and potential loss of transplantable organs. Collaborative practice and aggressive surveillance to determine loss of all neurologic function and evaluate possible autotriggering in this population is paramount and can minimise ICU stay, reduce costs of care, decrease family stress and facilitate recovery of transplantable organs.
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Affiliation(s)
- Richard B Arbour
- Former Critical Care Clinical Nurse Specialist, Albert Einstein Healthcare Network, 5501 Old York Road, Philadelphia, PA 19141-3211, USA.
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Meyer K, Bjørk IT, Eide H. Intensive care nurses’ perceptions of their professional competence in the organ donor process: a national survey. J Adv Nurs 2011; 68:104-15. [DOI: 10.1111/j.1365-2648.2011.05721.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Nicely B, DeLario G. Virginia Henderson's principles and practice of nursing applied to organ donation after brain death. Prog Transplant 2011. [DOI: 10.7182/prtr.21.1.c7617103jug3466m] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Virginia Henderson's Principles and Practice of Nursing Applied to Organ Donation after Brain Death. Prog Transplant 2011; 21:72-7. [DOI: 10.1177/152692481102100110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Registered nurses were some of the first nonphysician organ transplant and donation specialists in the field, both in procurement and clinical arenas. Nursing theories are abundant in the literature and in nursing curricula, but none have been applied to the donation process. Noted nursing theorist Virginia Henderson (1897–1996), often referred to as the “first lady of nursing,” developed a nursing model based on activities of living. Henderson had the pioneering view that nursing stands separately from medicine and that nursing consists of more than simply following physicians' orders. Henderson's Principles and Practice of Nursing is a grand theory that can be applied to many types of nursing. In this article, Henderson's theory is applied to the intensely focused and specialized area of organ donation for transplantation. Although organ donation coordinators may have backgrounds as physicians' assistants, paramedics, or other allied health professions, most are registered nurses. By virtue of the inherent necessity for involvement of the family and friends of the potential donor, Henderson's concepts are applied to the care and management of the organ donor, to the donor's family and friends, and in some instances, to the caregivers themselves.
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Moraes ELD, Silva LBDBE, Moraes TCD, Paixão NCDSD, Izumi NMS, Guarino ADJ. The profile of potential organ and tissue donors. Rev Lat Am Enfermagem 2009; 17:716-20. [DOI: 10.1590/s0104-11692009000500019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 08/03/2009] [Indexed: 11/22/2022] Open
Abstract
This study aimed to characterize donors according to gender, age group, cause of brain death; quantify donors with hypernatremia, hyperpotassemia and hypopotassemia; and get to know which organs were the most used in transplantations. This quantitative, descriptive, exploratory and retrospective study was performed at the Organ Procurement Organization of the University of São Paulo Medical School Hospital das Clínicas. Data from the medical records of 187 potential donors were analyzed. Cerebrovascular accidents represented 53.48% of all brain death causes, sodium and potassium disorders occurred in 82.36% of cases and 45.46% of the potential donors were between 41 and 60 years old. The results evidenced that natural death causes exceeded traumatic deaths, and that most donors presented sodium and potassium alterations, likely associated to inappropriate maintenance.
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Arbour R. Cardiogenic oscillation and ventilator autotriggering in brain-dead patients: a case series. Am J Crit Care 2009; 18:496, 488-95. [PMID: 19723871 DOI: 10.4037/ajcc2009690] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Brain death is manifested by a flaccid, areflexic patient on assessment of brain function with fixed and dilated pupils at midpoint, loss of consciousness, no response to stimulation, loss of brainstem reflexes, and apnea. A lesion or clinical state responsible for the loss of consciousness must be found. An integral part of clinical evaluation of brain death is apnea testing, which indicates complete loss of brainstem function and respiratory drive. Ventilator triggering or overbreathing the ventilator's set rate may be considered consistent with intrinsic respiratory drive consequent to residual brainstem function. Ventilator autotriggering, however, may potentially occur in a brain-dead patient as a result of interaction between the hyperdynamic cardiovascular system and compliant lung tissue altering airway pressure and flow patterns. Also, chest wall and precordial movements may mimic intrinsic respiratory drive. Ventilator autotriggering may delay determination of brain death, prolong the intensive care unit experience for patients and their families, increase costs, risk loss of donor organs, and confuse staff and family members. A detailed literature review and 3 cases of cardiogenic ventilator autotriggering are presented as examples of this phenomenon and highlight the value of close multidisciplinary clinical evaluation and examination of ventilator pressure and flow waveforms.
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Affiliation(s)
- Richard Arbour
- Richard Arbour is a clinical nurse specialist for critical care at Albert Einstein Medical Center in Philadelphia, Pennsylvania
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Lytle FT, Afessa B, Keegan MT. Progression of organ failure in patients approaching brain stem death. Am J Transplant 2009; 9:1446-50. [PMID: 19344436 DOI: 10.1111/j.1600-6143.2009.02575.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We performed a retrospective cohort study to document the progression of organ dysfunction in 182 critically ill adult patients who subsequently met criteria for brain stem death (BSD). Patients were admitted to intensive care units (ICUs) of Mayo Medical Center, Rochester, MN, between January 1996 and December 2006. Daily sequential organ failure assessment (SOFA) scores were used to assess the degree of organ dysfunction. Serial SOFA scores were analyzed using analysis of variance (ANOVA). Mean (standard deviation, SD) SOFA score on the first ICU day was 8.9 (3.2). SOFA scores did not significantly change over the course of ICU stay. 67.6% of patients donated one or more organs after BSD was declared. The median time from ICU admission to declaration of BSD was 18.8 h (interquartile range 10.3-45.0), and in those who donated organs, the time from declaration of BSD to organ retrieval was 11.8 h (9.5-17.6). The fact that mean SOFA scores did not change significantly over time, even after BSD occurred, has implications for the timing of retrieval of organs for transplantation.
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Affiliation(s)
- F T Lytle
- Division of Critical Care, Department of Anesthesiology, Mayo Clinic College of Medicine Rochester, MN, USA
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Relationship of Hormonal Resuscitation Therapy and Central Venous Pressure on Increasing Organs for Transplant. J Heart Lung Transplant 2009; 28:480-5. [DOI: 10.1016/j.healun.2009.01.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 11/11/2008] [Accepted: 01/14/2009] [Indexed: 11/19/2022] Open
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Zavotsky KE, Tamburri LM. A Case in Successful Organ Donation: Emergency Department Nurses Do Make a Difference. J Emerg Nurs 2007; 33:235-41. [PMID: 17517270 DOI: 10.1016/j.jen.2006.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 12/06/2006] [Accepted: 12/07/2006] [Indexed: 11/21/2022]
Affiliation(s)
- Kathleen Evanovich Zavotsky
- West Central Jersey Chapter, Emergency Department, Robert Wood Johnson University Hospital, New Brunswick, NJ 08903, USA.
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