Abstract：
PURPOSE:We investigated whether a critical rise of intracranial pressure (ICP) leading to a loss of cerebral perfusion pressure (CPP) could serve as a surrogate marker of brain death (BD). MATERIALS AND METHODS:We retrospectively analyzed ICP and CPP of patients in whom BD was diagnosed (n = 32, 16-79 years). Intracranial pressure and CPP were recorded using parenchymal (n = 27) and ventricular probes (n = 5). Data were analyzed from admission until BD was diagnosed. RESULTS:Intracranial pressure was severely elevated (mean ± SD, 95.5 ± 9.8 mm Hg) in all patients when BD was diagnosed. In 28 patients, CPP was negative at the time of diagnosis (-8.2 ± 6.5 mm Hg). In 4 patients (12.5%), CPP was reduced but not negative. In these patients, minimal CPP was 4 to 18 mm Hg. In 1 patient, loss of CPP occurred 4 hours before apnea completed the BD syndrome. CONCLUSIONS:Brain death was universally preceded by a severe reduction of CPP, supporting loss of cerebral perfusion as a critical step in BD development. Our data show that a negative CPP is neither sufficient nor a prerequisite to diagnose BD. In BD cases with positive CPP, we speculate that arterial blood pressure dropped below a critical closing pressure, thereby causing cessation of cerebral blood flow.
journal_name
J Crit Carejournal_title
Journal of critical careauthors
Salih F,Holtkamp M,Brandt SA,Hoffmann O,Masuhr F,Schreiber S,Weissinger F,Vajkoczy P,Wolf Sdoi
10.1016/j.jcrc.2016.03.009subject
Has Abstractpub_date
2016-08-01 00:00:00pages
1-6eissn
0883-9441issn
1557-8615pii
S0883-9441(16)00091-5journal_volume
34pub_type
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