Ventilator autotriggering : An underestimated phenomenon in the determination of brain death.

BACKGROUND: Ventilator autotriggering (VAT) may induce uncertainty in diagnosing brain death because it may falsely suggest a central respiratory drive in brain-dead patients where no intrinsic respiratory efforts exist. Since the lack of international standardization of brain death criteria contributes to the loss of potential donor organs, it is important to be aware of this phenomenon, which is a not well-known confounder in the process of diagnosing brain death. METHODS: The national official recommendations or guidelines for the determination of brain death and organ transplantation of 15 selected European countries (including all 8 member states of the Eurotransplant network) were evaluated with respect to VAT. In addition, a literature search (PubMed, Google Scholar) using the term "ventilator autotriggering", synonyms or similar content-related wording was carried out. RESULTS: The VAT phenomenon was mentioned in 3 of the 15 official recommendations and guidelines on diagnosing brain death. The causes and management of VAT are presented in different ways in the reviewed official recommendations and guidelines. CONCLUSION: The phenomenon of VAT is inconsistently addressed in the national guidelines and recommendations for the determination of brain death and should, therefore, be included in future harmonized brain death codes. Detection and correction of VAT should be implemented as early as possible by a structured procedure. Additional training and information on this phenomenon should be made available to the entire intensive care unit staff.

Research at the Department of Medical Informatics, Statistics and Documentation of the University of Graz.

The Department of Medical Informatics, Statistics and Documentation of the University of Graz has a double responsibility: research in medical informatics, and implementation and operation of information systems in the hospital. Research is therefore application oriented with emphasis on departmental information systems, image management, and information integration. Other topics include analysis of the preconditions for the acceptance and successful use of information systems in medicine, and the ethics and professional responsibility of medical informatics.