Year: 2025
Type: article
Study design: Case Report
Abstract: the patient was treated with fluid resuscitation and later required an injection of noradrenaline infusion.He was started on an injection of ceftriaxone, injection of levetiracetam, injection mannitol, and antacid prophylaxis.His brainstem reflexes were absent.Testing for brain death was initiated.Confounding variables were checked for and excluded if present.He was found to have brainstem areflexia.Relatives were prognosticated about the patient's condition.The relatives opted for organ donation.The apnea test was conducted thereafter.Prior to apnea testing, the patient was euvolemic, his core temperature was reported to be 37°C, blood pressure (BP) was 140/90 mm Hg, and PaCO₂ was 41 mm Hg.Post-preoxygenation, his PaO₂ was 476 mm Hg (Table 1).The PaO₂ eventually increased IntroductIonA significant injury to the brain and brainstem may result in brain death.Due to the resilience of the brainstem, this is not a very common condition.1 The prevalence of brain death was earlier estimated to be around 10% in those with an acute injury to the brain.2 This has shown a decline in the more recent years to approximately 5%. 3 Evaluation for brain death should be considered in patients who have suffered irreversible brain injury of known etiology.With regard to the clinical criteria, the determination of brain death requires the presence of irreversible coma, brainstem areflexia (loss of at least 3 brainstem reflexes), and absence of a breathing effort by the patient.This clinical diagnosis is supported by a conclusive apnea test.A carbon dioxide (CO₂) challenge is performed in this test.4 There are certain prerequisites that need to be met before initiating this test.These include systolic blood pressure >90 mm Hg, body temperature >36°C, a euvolemic state, as well as lack of acidosis and hypoxia.5 Usually, in this test, the presence of apnea for approximately 8-10 minutes is required to reach the target level of CO₂, which is 60 mm Hg or an increase of PaCO₂ of 20 mm Hg above the patient's baseline.6 Hereby, we present a patient with a road traffic accident (RTA) with traumatic brain injury, intracranial bleed, and areflexia of the brainstem with a prolonged apnea test. case descrIptIonA 31-year-old male, after an RTA, presented to our hospital with a Glasgow Coma Scale of 3/15 and an endotracheal tube in situ.He was unresponsive to central and peripheral noxious stimulation.A computed tomography (CT) brain was done, which showed diffuse subarachnoid hemorrhage (SAH) with bilateral subdural hematoma (SDH), pontine hemorrhage, and cerebral edema (Fig. 1).Initially,
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4409870000