Brain death: medical management in seven Brazilian pediatric intensive care units.
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.


CONCLUSIONS
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.
Lago
Patrícia M
PM
Unidade de Tratamento Intensivo Pediátrico, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil. lagopatricia@terra.com.br
Piva
Jefferson
J
Garcia
Pedro Celiny
PC
Troster
Eduardo
E
Bousso
Albert
A
Sarno
Maria Olivia
MO
Torreão
Lara
L
Sapolnik
Roberto
R
D001926:Brain Death / Q000175:diagnosis*; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D003430:Cross-Sectional Studies; D006801:Humans; D015994:Incidence; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000941:ethics*; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement