ABSTRACT
Objective:To construct a nomogram model for spontaneous respiratory arrest prediction in nerocritical patients within 72 hours after brain injury for early identification of potential brain death organ donors.Methods:From October 2017 to May 2019, 127 hospitalized neurocritical patients (including traumatic brain injury and spontaneous cerebral hemorrhage) were prospectively enrolled and the parameters related to brain injury were dynamically recorded. Among them, the data from October 1, 2017 to May 31, 2018 were used for constructing the training set and the data from June 1, 2018 to January 31, 2019 for constructing the validation set. The occurrence of spontaneous respiratory arrest within 72 h after brain injury was regarded as the time interest point and grouping factor. The factors associated with spontaneous respiratory arrest were screened by univariate and multivariate analyses. Then the Nomogarm prediction model was developed and tested in the validation set.Results:Sixty-five patients entered the training set and another 62 cases were enrolled into the validation set. In training set, univariate and multivariate analyses indicated that midline shift ( OR=4.56, 95%CI: 1.87~19.21), absent of ambient cistern ( OR=4.83, 95%CI: 1.35~16.34), cough reflex ( OR=3.82, 95%CI: 1.15~12.42), intraventricular hemorrhage ( OR=3.16, 95%CI: 1.53~14.52) and serum Na + <125 mmol/L ( OR=3.06, 95%CI: 1.53~13.44) were associated with spontaneous respiratory within 72 h. In both sets, the predicted C index of spontaneous respiratory arrest rate within 72 h was 0.81 (95%CI: 0.76~0.85) and 0.80 (95%CI 0.75~0.83) respectively. Further statistical analysis implied that 140, 160 and 170 points were the dangerous dividing points and these three points were 30.1%, 65.6% and 93.4% associated with spontaneous respiratory arrest within 72 h respectively. Conclusions:Nomogram model based upon assessment parameters of brain injury may predict the time of spontaneous respiratory arrest in neurocritical patients. It can be used for early identification of potential brain death organ donors. The results require further external data validation.
ABSTRACT
Objective By analyzing unusual movements of brain death organ donors before organ donation,to avoid misunderstanding and ensure the implementation of organ donation successfully.Methods Relevant clinical data of potential brain death organ donors admitted to the First Affiliated Hospital of Sun yat-sen University were prospectively collected between January 2016 and December 2017.The related parameters of neurological examination,neuroimaging examination and laboratory examination after brain death determination were dynamically recorded.The occurrence of limb,head and respiratory-like movement after brain death was defined as unusual movements,and the factors associated with unusual movements were screened by univariate and multivariate analysis.Results According to the inclusion criteria,164 patients were enrolled into this study.Twenty-two (13.4％) had unusual movements and duration was less than 72 h.Among them,21 (12.8％) had limbs unusual movements,6 (3.7％) had respiratory-like movement,5 (3％) owned both,and 4 (2.4％) had head rotation accompanied with limbs unusual movements.Univariate and multivariate analysis showed that axillary temperature ≤36 ℃,serum sodium ≤125 mmol/L,primary brain stem injury,spontaneous respiratory arrest time ≤72 h and age ≤ 18 years were associated with unusual movements.Conclusion During the clinical practice of brain death determination in China,the incidence of unusual movements is relatively low,and related to some factors,but it is extremely easy to cause misunderstanding.Correct cognition and interpretation are contributed to the successful implementation of organ donation.
ABSTRACT
Objective The purpose of this study was to improve the success of organ donation and organ quality by analyzing the hemodynamic stability effect of 3-durgs therapy in brain death donor.Methods In this prospective observational study,we collected clinical data of brain death donors,who was admitted in the First Affiliated Hospital,Sun Yet-sen University from October 2015 to December 2016."3-durgs" emphasizes simultaneous use and includes vasopressin,thyroxine and corticosteroids.The assessment of hemodynamics is based on blood pressure,heart rate,blood oxygen,urine volume,and vasoactive drugs.According to the time of admission,included patients were divided into two groups:3-durgs therapy group and conventional therapy group therapy group;the clinical data were compared between two groups to analyze the effect of 3-durgs on hemodynamic stability.Furthermore,we used univariate and multivariable logistic regression analyses to assess associations between 3-durgs therapy and these variables.Results A total of 109 patients were included in the study;following the time sequence,54 cases enter into the conventional therapy group received conventional therapy,32 cases achieved hemodynamic stability;55 cases in 3-durgs group received 3-durgs and conventional therapy,45 cases achieved hemodynamic stability,3-durgs group is better than the conventional group.In the matter of high-does usage,single vasoactive agent can maintain hemodynamic stability rate and norepinephrine usage,3-durgs group is better than the conventional group.The univariate and multivariable analysis showed that the abnormal suprasellar cistern,midline shift,low free T3,axillary temperature more than 36.5 ℃ and central diabetes insipidus are associated with 3-durgs-hormone therapy.Conclusion 3-durgs therapy can contribute to maintain hemodynamic stability in brain death donors and reduce the usage of vasoactive agents,can improve the success rate of donations and improve the quality of occupied organ;meanwhile,the screened validities can predict the effectiveness of 3-durgs therapy.