title: [Determination of brain death in Intensive Pediatric Therapy].
abstract: The subject of this paper is to report our experience in the determination of brain death in infants and children. We have retrospectively examined the incidence of brain death occurred in 504 consecutive children admitted to multidisciplinary pediatric ICU at "Bambino Gesù" Hospital of Rome during the years 1994 to 1997. According to current Italian Law, brain death was declared in 8 children (1.6%), whose primary diagnoses were: Meningitis (3 cases); nontraumatic intracerebral hemorrhage (2 cases); medulloblastoma (1 case); brain metastasis of neuroblastoma (1 case); SIDS (1 case). All brain death diagnoses were made using clinical criteria and confirmatory tests. A difficult problem was met in achieving the required Pa-CO2 values higher than 60 mmHg without unduly lowering O2 saturation. In order to obtain easily this objective we have recently switched the ventilator to intermittent mandatory volume ventilation at a rate of five stroke per minute using a FiO2 of 1 before starting the apnea test. In infants younger than one year the required cerebral circulatory arrest was documented in the pericallosal artery by doppler ultrasonography performed through the fonticuli cranii. The absence of cerebral blood flow was recorded for one to five days after clinical and electroencephalographic diagnosis of brain death, causing an unnecessary prolonged rianimative support. This also confirms that in young infants brain death may occur without a marked increase of intracranial pressure. Last, but not least, we believe that particular attention must be paid to psycho-emotional conditions of parents as well as of intensivists and nurses especially when brain death must be assessed in children.
authors.affiliation: Servizio di Anestesia e Rianimazione, Ospedale Pediatrico Bambino Gesu di Roma, Italia.
authors.forename: A
authors.initials: A
authors.lastname: Villani
authors.forename: A
authors.initials: A
authors.lastname: Onofri
authors.forename: R
authors.initials: R
authors.lastname: Bianchi
authors.forename: S
authors.initials: S
authors.lastname: Catena
authors.forename: M
authors.initials: M
authors.lastname: Cori
mesh_terms: D000818:Animals; D001926:Brain Death / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D006224:Cricetinae; D003422:Critical Care; D006801:Humans; D007223:Infant; D007231:Infant, Newborn
vernacular_title: L'accertamento della morte cerebrale in Terapia Intensiva Pediatrica.