RESUMO
OBJECTIVE: To analyze the profile, incidence of life support therapy limitation (LSTL) and donation potential in neurocritical patients. STUDY DESIGN: A multicenter prospective study was carried out. SETTING: Nine hospitals authorized for organ harvesting for transplantation. PATIENTS: All patients consecutively admitted to the hospital with GCS < 8 during a 6-month period were followed-up until discharge or day 30 of hospital stay. STUDY VARIABLES: Demographic data, cause of coma, clinical status upon admission and outcome were analyzed. LSTL, brain death (BD) and organ donation incidence were recorded. RESULTS: A total of 549 patients were included, with a mean age of 59.0 ± 14.5 years. The cause of coma was cerebral hemorrhage in 27.0% of the cases.LSTL was applied in 176 patients (32.1%). In 78 cases LSTL consisted of avoiding ICU admission. Age, the presence of contraindications, and specific causes of coma were associated to LSTL. A total of 58.1% of the patients died (n=319). One-hundred and thirty-three developed BD (24.2%), and 56.4% of these became organ donors (n=75). The presence of edema and mid-line shift on the CT scan, and transplant coordinator evaluation were associated to BD. LSTL was associated to a no-BD outcome. Early LSTL (first 4 days) was applied in 9 patients under 80 years of age, with no medical contraindications for donation and a GCS ≤ 4 who finally died in asystole. CONCLUSIONS: LSTL is a frequent practice in neurocritical patients. In almost one-half of the cases, LSTL consisted of avoiding admission to the ICU, and on several occasions the donation potential was not evaluated by the transplant coordinator.
Assuntos
Morte Encefálica , Coma/terapia , Cuidados Críticos , Eutanásia Passiva , Cuidados para Prolongar a Vida , Recusa em Tratar/estatística & dados numéricos , Doadores de Tecidos/provisão & distribuição , Coleta de Tecidos e Órgãos , Obtenção de Tecidos e Órgãos/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Dano Encefálico Crônico/etiologia , Morte Encefálica/diagnóstico , Coma/etiologia , Coma/mortalidade , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Cuidados para Prolongar a Vida/estatística & dados numéricos , Masculino , Futilidade Médica , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha , Assistência Terminal/estatística & dados numéricos , Coleta de Tecidos e Órgãos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/métodosRESUMO
Objetivo. Analizar el perfil, la incidencia de limitaciónde tratamiento de soporte vital (LTSV) y la potencialidad de donación de órganos enpacientes neurocríticos. Diseño Multicéntrico prospectivo. Ámbito Nueve centros autorizados para extracción de órganos para trasplante...