Traumatic Brain Injury (Stocchetti)
GCS has its’ limitations on ICU
In traumatic head injuries, liaise with neurosurgical colleagues early
Repeat CT brain routinely 12-24 hours or sooner if concerns
References
ESICM Guide to assessing neurology of patients on ICU
Prognostication post TBI in CRASH Trial
Brain death (Rothen)
The number of people waiting for organ transplant is increasing
Brain death pathophysiology
- Sympathetics storm
- Loss vasomotor control
- Loss respiratory control
- Endocrine changes; pituitary failure, thyroid failure, hyperglycaemia
Increased ICP -> early compensatory arterial hypertension (Cushing reflex) -> ‘sympathetic storm’ -> loss of vasomotor tone and peripheral vasodilatation
Protocolised care improves the management of organ donors
References
www.cobatrice.org
Management of potential organ donor
UK guide for diagnosis of brain death
Organ donor management targets
Protocolised care for organ donor: MONITOR Trial
Organ donation (Guttermsen)
Huge discrepancy in demand and organ donation
Types of donors
- Living donor
- Heart-beating, brain dead donor (BSD)
- Non-heart beating donor (DCD)
References
European report on organ transplants
Donation after circulatory death