Can cerebral hypoperfusion after sympathetic storm be used to diagnose brain death? A retrospective survey in traumatic brain injury patients

Chung Liang Chai, Yong Kwang Tu, Sheng Jean Huang

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND: The aim of this study was to identify the precise time of occurrence of irreversible coma from brain stem dysfunction that precedes brain death. Sympathetic storm, which is a cardiovascular hyperdynamic state manifested by brain stem ischemia, is known to be related to brain stem failure in animal models. We studied sympathetic storm in the clinical setting and compared the clinical findings observed before and after sympathetic storm to identify the precise time of occurrence of irreversible apneic coma. METHODS: We conducted a retrospective study of 15 comatose traumatic brain injury adult patients at the National Taiwan University Hospital's Neurosurgical Intensive Care Unit. Data on arterial blood pressure, heart rate, intracranial pressure, and clinical findings such as cerebral blood flow pattern, Glasgow Coma Scale, brain stem reflexes, utilizations of catecholamines, and occurrence of central diabetes insipidus throughout the course in the intensive care unit were collected retrospectively from medical records. RESULTS: Prolonged uncorrectable cerebral hypoperfusion was found after a characteristic irreversible apneic coma-associated sympathetic storm (IACASS) in all 15 patients. A mean cerebral perfusion pressure of 11.9 mm Hg ± 10.3 mm Hg and 13 mm Hg ± 3.5 mm Hg remained at 12 hours and 24 hours, respectively, after IACASS. Differences in clinical findings before and after IACASS that were statistically significant were cerebral circulation pattern (p = 0.0455), Glasgow Coma Scale (p = 0.0143), brain stem reflexes (p = 0.0143), utilization of catecholamines (p = 0.0254), and occurrence of central diabetes insipidus (p = 0.00468). CONCLUSIONS: Coma might have become irreversible immediately after IACASS because the prolonged duration of cerebral hypoperfusion could have caused irreversible cerebral tissue injury. Our study provides some preliminary findings suggesting that IACASS may be a predictor of impending brain death. A prospective study is the next step to understanding whether this phenomenon can be applied clinically to diagnose irreversible apneic coma.

Original languageEnglish
Pages (from-to)688-697
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume64
Issue number3
DOIs
Publication statusPublished - Mar 1 2008
Externally publishedYes

Fingerprint

Brain Death
Cerebrovascular Circulation
Brain Stem
Neurogenic Diabetes Insipidus
Glasgow Coma Scale
Coma
Catecholamines
Intensive Care Units
Reflex
Traumatic Brain Injury
Surveys and Questionnaires
Intracranial Pressure
Brain Ischemia
Taiwan
Medical Records
Arterial Pressure
Animal Models
Retrospective Studies
Heart Rate
Prospective Studies

Keywords

  • Brain death
  • Irreversible apneic coma
  • Sympathetic storm
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Can cerebral hypoperfusion after sympathetic storm be used to diagnose brain death? A retrospective survey in traumatic brain injury patients",
abstract = "BACKGROUND: The aim of this study was to identify the precise time of occurrence of irreversible coma from brain stem dysfunction that precedes brain death. Sympathetic storm, which is a cardiovascular hyperdynamic state manifested by brain stem ischemia, is known to be related to brain stem failure in animal models. We studied sympathetic storm in the clinical setting and compared the clinical findings observed before and after sympathetic storm to identify the precise time of occurrence of irreversible apneic coma. METHODS: We conducted a retrospective study of 15 comatose traumatic brain injury adult patients at the National Taiwan University Hospital's Neurosurgical Intensive Care Unit. Data on arterial blood pressure, heart rate, intracranial pressure, and clinical findings such as cerebral blood flow pattern, Glasgow Coma Scale, brain stem reflexes, utilizations of catecholamines, and occurrence of central diabetes insipidus throughout the course in the intensive care unit were collected retrospectively from medical records. RESULTS: Prolonged uncorrectable cerebral hypoperfusion was found after a characteristic irreversible apneic coma-associated sympathetic storm (IACASS) in all 15 patients. A mean cerebral perfusion pressure of 11.9 mm Hg ± 10.3 mm Hg and 13 mm Hg ± 3.5 mm Hg remained at 12 hours and 24 hours, respectively, after IACASS. Differences in clinical findings before and after IACASS that were statistically significant were cerebral circulation pattern (p = 0.0455), Glasgow Coma Scale (p = 0.0143), brain stem reflexes (p = 0.0143), utilization of catecholamines (p = 0.0254), and occurrence of central diabetes insipidus (p = 0.00468). CONCLUSIONS: Coma might have become irreversible immediately after IACASS because the prolonged duration of cerebral hypoperfusion could have caused irreversible cerebral tissue injury. Our study provides some preliminary findings suggesting that IACASS may be a predictor of impending brain death. A prospective study is the next step to understanding whether this phenomenon can be applied clinically to diagnose irreversible apneic coma.",
keywords = "Brain death, Irreversible apneic coma, Sympathetic storm, Traumatic brain injury",
author = "Chai, {Chung Liang} and Tu, {Yong Kwang} and Huang, {Sheng Jean}",
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T1 - Can cerebral hypoperfusion after sympathetic storm be used to diagnose brain death? A retrospective survey in traumatic brain injury patients

AU - Chai, Chung Liang

AU - Tu, Yong Kwang

AU - Huang, Sheng Jean

PY - 2008/3/1

Y1 - 2008/3/1

N2 - BACKGROUND: The aim of this study was to identify the precise time of occurrence of irreversible coma from brain stem dysfunction that precedes brain death. Sympathetic storm, which is a cardiovascular hyperdynamic state manifested by brain stem ischemia, is known to be related to brain stem failure in animal models. We studied sympathetic storm in the clinical setting and compared the clinical findings observed before and after sympathetic storm to identify the precise time of occurrence of irreversible apneic coma. METHODS: We conducted a retrospective study of 15 comatose traumatic brain injury adult patients at the National Taiwan University Hospital's Neurosurgical Intensive Care Unit. Data on arterial blood pressure, heart rate, intracranial pressure, and clinical findings such as cerebral blood flow pattern, Glasgow Coma Scale, brain stem reflexes, utilizations of catecholamines, and occurrence of central diabetes insipidus throughout the course in the intensive care unit were collected retrospectively from medical records. RESULTS: Prolonged uncorrectable cerebral hypoperfusion was found after a characteristic irreversible apneic coma-associated sympathetic storm (IACASS) in all 15 patients. A mean cerebral perfusion pressure of 11.9 mm Hg ± 10.3 mm Hg and 13 mm Hg ± 3.5 mm Hg remained at 12 hours and 24 hours, respectively, after IACASS. Differences in clinical findings before and after IACASS that were statistically significant were cerebral circulation pattern (p = 0.0455), Glasgow Coma Scale (p = 0.0143), brain stem reflexes (p = 0.0143), utilization of catecholamines (p = 0.0254), and occurrence of central diabetes insipidus (p = 0.00468). CONCLUSIONS: Coma might have become irreversible immediately after IACASS because the prolonged duration of cerebral hypoperfusion could have caused irreversible cerebral tissue injury. Our study provides some preliminary findings suggesting that IACASS may be a predictor of impending brain death. A prospective study is the next step to understanding whether this phenomenon can be applied clinically to diagnose irreversible apneic coma.

AB - BACKGROUND: The aim of this study was to identify the precise time of occurrence of irreversible coma from brain stem dysfunction that precedes brain death. Sympathetic storm, which is a cardiovascular hyperdynamic state manifested by brain stem ischemia, is known to be related to brain stem failure in animal models. We studied sympathetic storm in the clinical setting and compared the clinical findings observed before and after sympathetic storm to identify the precise time of occurrence of irreversible apneic coma. METHODS: We conducted a retrospective study of 15 comatose traumatic brain injury adult patients at the National Taiwan University Hospital's Neurosurgical Intensive Care Unit. Data on arterial blood pressure, heart rate, intracranial pressure, and clinical findings such as cerebral blood flow pattern, Glasgow Coma Scale, brain stem reflexes, utilizations of catecholamines, and occurrence of central diabetes insipidus throughout the course in the intensive care unit were collected retrospectively from medical records. RESULTS: Prolonged uncorrectable cerebral hypoperfusion was found after a characteristic irreversible apneic coma-associated sympathetic storm (IACASS) in all 15 patients. A mean cerebral perfusion pressure of 11.9 mm Hg ± 10.3 mm Hg and 13 mm Hg ± 3.5 mm Hg remained at 12 hours and 24 hours, respectively, after IACASS. Differences in clinical findings before and after IACASS that were statistically significant were cerebral circulation pattern (p = 0.0455), Glasgow Coma Scale (p = 0.0143), brain stem reflexes (p = 0.0143), utilization of catecholamines (p = 0.0254), and occurrence of central diabetes insipidus (p = 0.00468). CONCLUSIONS: Coma might have become irreversible immediately after IACASS because the prolonged duration of cerebral hypoperfusion could have caused irreversible cerebral tissue injury. Our study provides some preliminary findings suggesting that IACASS may be a predictor of impending brain death. A prospective study is the next step to understanding whether this phenomenon can be applied clinically to diagnose irreversible apneic coma.

KW - Brain death

KW - Irreversible apneic coma

KW - Sympathetic storm

KW - Traumatic brain injury

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