Authors: Smith, Michael Louis; Counelis, George; Maloney-Wilensky, Eileen; Stiefel, Michael; Donley, Kathy; LeRoux, Peter

Source: Neurological Research, Volume 29, Number 7, October 2007 , pp. 755-759(5)

Publisher: Maney Publishing

Abstract:

Objectives: Brain death is a clinical diagnosis often confirmed with supplementary tests. In this study, we examined the relationship between brain death and the partial pressure of brain tissue oxygen (PbtO₂). We hypothesized that a sustained PbtO₂ of 0 is associated with brain death.

Methods: One hundred and twenty-six patients (Glasgow coma scale ? 8, median age: 50 years) who underwent PbtO₂ monitoring were studied prospectively during a 2 year period in the neurointensive care unit at a university-based level I trauma center. PbtO₂, intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP) and brain temperature (BT) were compared before and after the diagnosis of brain death.

Results: Six patients (median age: 52 years) experienced brain death. In these patients, PbtO₂ decreased toward 0 mmHg as ICP increased and CPP decreased. PbtO₂ reached 0 only when there was clinical evidence for brain death. During the subsequent 12 hours until the second brain death examination, PbtO₂ remained 0 mmHg and did not respond to oxygen challenge. In addition, TCD examination demonstrated a 'to and fro' pattern consistent with brain death and cerebral circulatory arrest. PbtO₂ of 0 mmHg was observed in five non-brain dead patients. These episodes were transient (>30 minutes) and responded to an oxygen challenge, directed treatment or catheter replacement.

Discussion: A sustained (>30 minutes) brain PbtO₂ of 0 is consistent with brain death. We suggest that a sustained 'zero' PbtO₂ may be used to determine when a brain death examination is appropriate in the pharmacologically suppressed patient.

Keywords: MULTIMODAL MONITORING; BRAIN TISSUE OXYGEN; BRAIN DEATH; CEREBRAL OXYGENATION; SEVERE HEAD INJURY

Document Type: Research Article

DOI: http://dx.doi.org/10.1179/016164107X208121

Affiliations: Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA

Publication date: 2007-10-01

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