0
Critical Care |

A Case of Brain Death in the Medical Intensive Care Unit

Paul Hutchison, MD; Naomi Kern, FNP; Jessica Altman, MD; Thomas Corbridge, MD
Author and Funding Information

Northwestern University, Chicago, IL


Chest. 2013;144(4_MeetingAbstracts):280A. doi:10.1378/chest.1698515
Text Size: A A A
Published online

Abstract

SESSION TITLE: Critical Care Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: While brain death is not uncommon in intensive care units (ICUs) specializing in neurologic illness, it is a rare mechanism of death in medical ICUs.

CASE PRESENTATION: A 23 year-old male patient with acute myelogenous leukemia was admitted to an inpatient oncology unit for a stem cell transplant; his course was complicated by Clostridium difficile colitis and pancytopenia. On morning rounds he was found to be acutely somnolent and minimally interactive, and he required transfer to the medical ICU. He was intubated for airway protection and treated for hypotension with intravenous fluids and vasopressors. Two hours later the resident was called to the room for dilated, nonreactive pupils and lack of response to noxious stimuli. Head CT revealed diffuse intraparenchymal and subarachnoid hemorrhage and subdural hematomas. Examinations by a neurologist and the ICU attending, which included cold caloric testing, the occulocephalic maneuver, elicitation of brain stem reflexes and apnea challenge were consistent with brain death. The attending physician declared the patient brain dead and communicated this to the family; however, the family disagreed with the diagnosis given the presence of a heartbeat. The team decided to continue treatment for a short time to allow the family to process this information, but it felt the immediate tension between continuing mechanical ventilation and nursing treatment in a deceased patient and the desire to respect alternate viewpoints. The following day the family accepted the diagnosis and the patient was disconnected from the ventilator.

DISCUSSION: Despite publication of the “Harvard Criteria” in 1968 and the prevalence of brain death in cases of organ donation, it continues to pose clinical challenges (1). In particular, a declaration of death while a patient demonstrates a heart rhythm and blood pressure on in-room monitors can be confusing for family members. Similarly, healthcare professionals who are not familiar with these scenarios may be very uncomfortable caring for these patients. We believe that treating this patient for a short period of time was useful to the family and was in keeping with previously published recommendations (2).

CONCLUSIONS: It is incumbent on ICU clinicians to ensure context-appropriate care of patients declared brain dead as families cope and prepare for discontinuation of medical therapies. However, continuation of treatments must be balanced with responsible use of ICU resources.

Reference #1: Wijdicks EFM. The diagnosis of brain death. N Engl J Med 2001; 344:1215-1221.

Reference #2: Hardwig J. Treating the brain dead for the benefit of the family. J Clin Ethics 1991;2:53-6.

DISCLOSURE: The following authors have nothing to disclose: Paul Hutchison, Naomi Kern, Jessica Altman, Thomas Corbridge

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543