Dijagnostika moždane smrti

master's thesis

• Title (english): Diagnosis of brain death
• Author: Klara Petošić
• Mentor: Tomislav Radočaj (mentor)
• Committee member: Marinko Vučić (predsjednik povjerenstva)
• Committee member: Dinko Tonković (član povjerenstva)
• Committee member: Tomislav Radočaj (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Moždana smrt predstavlja trajni gubitak svijesti te ireverzibilnu disfunkciju mozga i moždanog debla. Čini 1-2% svih smrti. Moždano mrtvi pacijenti najbolji su kandidati za donore organa stoga je vrlo bitno poznavati postupak dijagnosticiranja moždane smrti.
Postupak utvrđivanja moždane smrti može započeti samo ako je utvrđen i objektivno dokumentiran ireverzibilni uzrok kome. Reverzibilni uzroci kome koji mogu oponašati moždanu smrt moraju biti isključeni.
Moždana smrt predstavlja prvenstveno kliničku dijagnozu. Fizikalnim pregledom utvrđuju se klinički znakovi moždane smrti. Potrebno je zadovoljiti tri klinička kriterija: duboka koma, odsutnost refleksa moždanog debla i pozitivan apneja test. Moždano mrtvi pacijenti u dubokoj komi imaju GCS 3. Svi refleksi moždanog debla su odsutni. Ispituje se: reaktivnost zjenica na svjetlo, kornealni refleks, reakcija na bolni podražaj u području inervacije trigeminalnog živca, okulocefalični i okulovestibularni refleks, faringealni i trahealni refleks, atonija muskulature te atropinski test. Apneja test neće potaknuti spontanu respiratornu aktivnost. Test se smatra pozitivnim ako PaCO2 postane veći od 60mmHg ili se PaCO2 povisi za 20mmHg na referentnu vrijednost.
Fizikalni pregled uputno je dopuniti minimalno jednim potvrdnim parakliničkim testom, pogotovo ako postoji sumnja u kliničku dijagnozu moždane smrti. Najčešće se izvode EEG, evocirani moždani potencijali, angiografija mozga i transkranijalna Doppler sonografija.
Moždana smrt proglašava se nakon dva uzastopna fizikalna pregleda. Preglede obavlja povjerenstvo sastavljano od minimalno dva liječnika specijalista. Daljnji dijagnostički i terapijski postupci su neprikladni i nepotrebni nakon proglašenja moždane smrti. Jedinu iznimku čine darovatelji dijelova tijela za transplantaciju.

Abstract (english)

Brain death is defined as a permanent loss of consciousness and irreversible dysfunction of the brain and the brainstem. It is diagnosed in 1-2% of all deaths. Brain-dead patients are the best candidates for organ transplantation so it is very important to know the procedure of brain death diagnosis.
Irreversible cause of coma must be identified and objectively documented to start the process of brain death determination. Reversible causes of coma that may mimic brain death must be ruled out.
Brain death is primarily a clinical diagnosis. Physical examination reveals clinical signs of brain death. Three clinical criteria need to be met: deep coma, absence of brainstem reflexes and positive apnea test. Brain-dead patients are in deep coma when the Glasgow Coma score is 3. Secondly, all brainstem reflexes are absent. The following reflexes are examined: pupillary response to light, corneal reflex, facial movement in response to noxious stimuli, oculocephalic and oculovestibular reflexes, gag and reflexes, muscular atonia and atropine test. Apnea test includes absence of spontaneous respiratory efforts. The test is considered positive if PaCO2 becomes greater than 60mmHg or PaCO2 rises by 20 mmHg above baseline.
At least one ancillary test is recommended to overcome any doubt about the accuracy of a clinical diagnosis of brain death. The most commonly performed ancillary tests are EEG, multimodal evoked potentials, brain angiography and transcranial Doppler sonography.
The two examinations must be performed by at least two specialists. Further diagnostic and therapeutic procedures are inappropriate and unnecessary after declaring brain death. The only exception for maintaining life support is to preserve organs for transplantation.

• Keywords: moždana smrt; dijagnostika moždane smrti; refleksi moždanog debla; apneja test; paraklinički testovi
• Keywords (english): brain death; diagnosis of brain death; brainstem reflexes; apnea test; ancillary tests
• Language: croatian
• URN:NBN: urn:nbn:hr:105:470216
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-27 10:45:28