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Brain death after severe traumatic brain injury: the role of systemic secondary brain insults.

Abstract：

:Secondary brain insults predominantly due to hypotension are frequent among patients with fatal traumatic brain injury. We assessed the correlation between different systemic secondary brain insults and brain death in 404 patients admitted to our intensive care unit (ICU) after severe traumatic brain injury. We collated data on hypoxemia and hypotension prior to as well as the occurrence of hypoxemia, hypotension, shock, anemia, hyperglycemia, and hyperthermia within the first 24 hours after ICU admission. We also considered both the presence of extracranial injuries and the category of traumatic brain injury using computerized tomography. The 59 patients (14.6%) who developed brain death, were significantly older than patients without a fatal neurological outcome (46.1 +/- 22 vs 29.5 +/- 14.9 years; P < .0001). Intracranial mass lesions, whether surgically evacuated were more frequent among brain-dead patients. The systemic secondary brain insults significantly associated with brain death were hypoxemia, hypotension, shock, anemia, and hyperglycemia within the first 24 hours after ICU admission. After multivariate analysis, the factors that independently predicted brain death were the occurrence of shock (odds ratio [OR], 6.74; 95% confidence interval [CI], 2.85-15.84; P = .001) and older age (OR, 1.05; 95% CI, 1.03-1.07; P = .003). In conclusion, early shock seems to be the major systemic secondary brain insult associated with brain death in patients with severe traumatic brain injury. Prevention of or correction of shock might help to either decrease the occurrence of a fatal neurological outcome or in brain-dead patients to preserve organs in better condition for procurement.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Sánchez-Olmedo JI,Flores-Cordero JM,Rincón-Ferrari MD,Pérez-Alé M,Muñoz-Sánchez MA,Domínguez-Roldán JM,Murillo-Cabezas F

doi

10.1016/j.transproceed.2005.03.048

subject

Has Abstract

pub_date

2005-06-01 00:00:00

pages

1990-2

issue

5

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(05)00285-X

journal_volume

37

pub_type

杂志文章

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