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Published on: March 26, 2019
Brain death: medical management in seven Brazilian pediatric intensive care units
Patrícia M Lago1, Jefferson Piva, Pedro Celiny Garcia
1Unidade de Tratamento Intensivo Pediátrico, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil. lagopatricia@terra.com.br
Insights
Brain death (BD) occurred in 11.6% of pediatric deaths in Brazil, with significant variations in diagnosis confirmation and life support withdrawal times. Adherence to BD protocols and organ donation rates were suboptimal.
Area of Science:
- Pediatric Critical Care Medicine
- Neurology
- Organ Donation and Transplantation
Background:
- Brain death (BD) determination and management protocols are critical in pediatric intensive care units (PICUs).
- Variations in adherence to BD protocols can impact patient care and organ donation rates.
- Understanding the incidence and management of BD in Brazil is essential for improving outcomes.
Purpose of the Study:
- To determine the incidence of brain death (BD) in Brazilian pediatric intensive care units (PICUs).
- To evaluate the medical management and protocols adopted after BD diagnosis.
- To identify regional differences in BD diagnosis and management across Brazil.
Main Methods:
- A multicenter, cross-sectional study involving retrospective medical record review.
- Data collected from seven PICUs across three Brazilian regions between January 2003 and December 2004.
- Trained pediatric intensive care residents utilized a standardized protocol for data collection.
Main Results:
- Brain death (BD) was identified in 11.6% of 525 deaths, with significant inter-unit variation (p = 0.015).
- Intracranial hemorrhage was the most common cause of BD (31.1%).
- Diagnosis confirmation varied by region (100% South, 68% Southeast, 72% Northeast; p = 0.02), and life support withdrawal times differed significantly across regions (p < 0.01).
- Only 9.8% of children with BD became organ donors.
Conclusions:
- Adherence to Brazilian brain death (BD) determination laws is inconsistent.
- Unnecessary life support is prolonged for deceased individuals due to protocol deviations.
- Pediatric intensive care units (PICUs) have limited involvement in organ donation processes.
Objective:
To assess the incidence of brain death (BD) and its medical management and adopted protocols after its diagnosis in seven pediatric intensive care units (PICUs) located in three Brazilian regions.
Methods:
A cross-sectional and multicenter study was conducted, based on the retrospective review of medical records regarding all deaths that occurred between January 2003 and December 2004 in seven Brazilian PICUs of tertiary hospitals located in Porto Alegre (two), São Paulo (two) and Salvador (three). Two pediatric intensive care residents from each hospital were previously trained and filled out a standard protocol for the investigation of demographic data, cause of death, diagnosis of BD, related protocols and subsequent medical management.
Results:
A total of 525 death patients were identified and 61 (11.6%) were defined as BD. The incidence of BD was different (p = 0.015) across the seven PICUs, but with no difference across the three regions. Intracranial hemorrhage was the most frequent cause of BD (31.1%). In 80% of the cases the diagnosis of BD was confirmed by complementary exams (south = 100%, southeast = 68% and northeast = 72%; p = 0.02). The interval between the diagnosis of BD and the withdrawal of life support was different (p < 0.01) across the three regions, being faster (p = 0.04) in the south (1.8+/-1.9 h) than in the southeast (28.6+/-43.2 h) and than in the northeast (15.5+/-17.1 h). Only six (9.8%) children with BD were organ donors.
Conclusion:
Although a Brazilian law defining the criteria for the determination of BD has been in place since 1997, we verified that it is not followed as strictly as it should be. Consequently, unnecessary life support is offered to deceased individuals, and there is a discrete involvement of PICUs in organ donation.
