Neurocritical Care

, Volume 12, Issue 1, pp 56–61 | Cite as

Brain Tissue Oxygenation in Children Diagnosed With Brain Death

Original Article
First Online:

Abstract

Background

Diagnosing brain death in children is challenging. Guidelines recommend using confirmatory testing to provide ancillary information to support the diagnosis. Brain tissue oxygenation (PbtO2) is being increasingly used in the adult neurocritical care for continuous monitoring of the adequacy of brain oxygenation; however, data in pediatrics is limited. Evidence from adult studies suggests that persistent PbtO2 of 0 mmHg is associated with brain death, but this relationship has not yet been demonstrated in children; therefore, we examined our experience with PbtO2 monitoring and brain death in children with acute neurological pathology.

Methods

We retrospectively reviewed patient records from a prospectively maintained database of 85 children who were ventilated for coma due to acute neurological injury and who received intracerebral monitoring.

Results

We identified five children who had suffered brain death while being monitored. PbtO2 had decreased to 0 mmHg in all five children at the time of brain death diagnosis. In contrast, PbtO2 in patients, who did not develop brain death, never decreased to 0 mmHg. We review the benefits and drawbacks of using brain tissue oxygenation as ancillary information in diagnosing brain death in children.

Conclusions

Preliminary data from this study suggest that PbtO2 decreases to 0 mmHg when brain death occurs in children. Further study is needed to determine the limitations, and the sensitivity and specificity of this finding in a larger group of children.

Keywords

MeSH-brain tissue oxygenation Children Brain death Traumatic brain injury 
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References

  1. 1.
    President’s Commission. Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA 1981; 246(19):2184–6.Google Scholar
  2. 2.
    Academy of Medical Royal Colleges. A code of practice for the diagnosis and confirmation of death. London: Academy of the Medical Royal Colleges; 2008.Google Scholar
  3. 3.
    Academy of Medical Royal Colleges. A code of practice for the diagnosis of brain stem death. London: Department of health; 1998.Google Scholar
  4. 4.
    Australian and New Zealand Intensive Care Society. Recommendations on brain death and organ donation. 2nd ed. Melbourne: Australian and New Zealand Intensive Care Society; 1998.Google Scholar
  5. 5.
    Task Force for the Determination of Brain Death in Children. Guidelines for the determination of brain death in children. Task Force for the Determination of Brain Death in Children. Arch Neurol. 1987;44(6):587–8.Google Scholar
  6. 6.
    Green JB, Lauber A. Return of EEG activity after electrocerebral silence: two case reports. J Neurol Neurosurg Psychiatry. 1972;35(1):103–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Montes JE, Conn AW. Near-drowning: an unusual case. Can Anaesth Soc J. 1980;27(2):172–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Shemie SD, Pollack MM, Morioka M, Bonner S. Diagnosis of brain death in children. Lancet Neurol. 2007;6(1):87–92.CrossRefPubMedGoogle Scholar
  9. 9.
    Baines PB. Diagnosis and management of brain death in children. Curr Paediatr. 2005;15(4):301–7.CrossRefGoogle Scholar
  10. 10.
    Kohrman MH, Spivack BS. Brain death in infants: sensitivity and specificity of current criteria. Pediatr Neurol. 1990;6(1):47–50.CrossRefPubMedGoogle Scholar
  11. 11.
    Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology. 2002;58(1):20–5.PubMedGoogle Scholar
  12. 12.
    Bell MDD, Moss E, Murphy PG. Brainstem death testing in the UK—time for reappraisal? Br J Anaesth. 2004;92(5):633–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Heran MK, Heran NS, Shemie SD. A review of ancillary tests in evaluating brain death. Can J Neurol Sci. 2008;35(4):409–19.PubMedGoogle Scholar
  14. 14.
    Blend MJ, Pavel DG, Hughes JR, et al. Normal cerebral radionuclide angiogram in a child with electrocerebral silence. Neuropediatrics. 1986;17(3):168–70.CrossRefPubMedGoogle Scholar
  15. 15.
    Drake B, Ashwal S, Schneider S. Determination of cerebral death in the pediatric intensive care unit. Pediatrics. 1986;78(1):107–12.PubMedGoogle Scholar
  16. 16.
    Monterio LM, Bollen CW, van Huffelen AC, Ackerstaff RGA, Jansen NJG, van Vught AJ. Transcranial Doppler ultrasonography to confirm brain death: a meta analysis. Intensive Care Med. 2006;32:1937–44.CrossRefGoogle Scholar
  17. 17.
    Maas AI, Fleckenstein W, de Jong DA, et al. Monitoring cerebral oxygenation: Experimental studies and preliminary clinical results of continuous monitoring of cerebrospinal fluid and brain tissue oxygen tension. Acta Neurochir Suppl (Wien). 1993;59:50–7.Google Scholar
  18. 18.
    Guidelines for the management of severe traumatic brain injury. J Neurotrauma 2007; 24(suppl 1): chapter X. doi:  10.1089/neu.2007.9999.
  19. 19.
    Figaji AA, Fieggen AG, Argent AC, Leroux PD, Peter JC. Does adherence to treatment targets in children with severe traumatic brain injury avoid brain hypoxia? A brain tissue oxygenation study. Neurosurgery. 2008;63(1):83–91.CrossRefPubMedGoogle Scholar
  20. 20.
    Figaji AA, Zwane E, Thompson C, et al. Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury: part 1: relationship with outcome 2009 (epub before print).Google Scholar
  21. 21.
    Stiefel MF, Udoetuk JD, Spiotta AM, Gracias VH, Goldberg A, Maloney-Wilensky E, et al. Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J Neurosurg. 2006;105(4):568–75.CrossRefPubMedGoogle Scholar
  22. 22.
    Valadka AB, Gopinath SP, Contant CF, Uzura M, Robertson CS. Relationship of brain tissue PO2 to outcome after severe head injury. Crit Care Med. 1998;26(9):1576–81.CrossRefPubMedGoogle Scholar
  23. 23.
    Scheufler KM, Röhrborn HJ, Zentner J. Does tissue oxygen-tension reliably reflect cerebral oxygen delivery and consumption? Anesth Analg. 2002;95:1042–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Smith ML, Counelis GJ, Maloney-Wilensky E, Stiefel MF, Donley K, LeRoux PD. Brain tissue oxygen tension in clinical brain death: a case series. Neurol Res. 2007;29(7):755–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Palmer S, Bader MK. Brain tissue oxygenation in brain death. Neurocrit Care. 2005;1(2):17–22.CrossRefGoogle Scholar
  26. 26.
    Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chap. 4. Resuscitation of blood pressure and oxygenation and prehospital brain-specific therapies for the severe pediatric traumatic brain injury patient. Pediatr Crit Care Med. 2003;4:S65–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Lang EW, Mulvey JM, Mudaliar Y, Dorsch NWC. Direct cerebral oxygenation monitoring—a systematic review of recent publications. Neurosurg Rev. 2007;30(2):1437–2320.CrossRefGoogle Scholar
  28. 28.
    Stiefel MF, Udoetuk JD, Storm PB, et al. Brain tissue oxygen monitoring in pediatric patients with severe traumatic brain injury. J Neurosurg. 2006;105:281–6.PubMedGoogle Scholar
  29. 29.
    Narotam PK, Burjonrappa SC, Raynor SC, et al. Cerebral oxygenation in major pediatric trauma: its relevance to trauma severity and outcome. J Pediatr Surg. 2006;41:505–13.CrossRefPubMedGoogle Scholar
  30. 30.
    Valadka AB, Hlatky R, Furuya Y, et al. Brain tissue PO2: correlation with cerebral blood flow. Acta Neurochir Suppl. 2002;81:299–301.PubMedGoogle Scholar
  31. 31.
    Scheufler KM, Lehnert A, Rohrborn HJ, et al. Individual value of brain tissue oxygen pressure, microvascular oxygen saturation, cytochrome redox level, and energy metabolites in detecting critically reduced cerebral energy state during acute changes in global cerebral perfusion. J Neurosurg Anesthesiol. 2004;16:210–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Doppenberg EM, Watson JC, Broaddus WC, et al. Intraoperative monitoring of substrate delivery during aneurysm and hematoma surgery: initial experience in 16 patients. J Neurosurg. 1997;87:809–16.CrossRefPubMedGoogle Scholar

Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  1. 1.University of Cape TownCape TownSouth Africa
  2. 2.University of AberdeenAberdeenScotland, UK

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