dc.contributor.author | Soita, Wycliffe C | |
dc.date.accessioned | 2024-05-07T07:32:09Z | |
dc.date.available | 2024-05-07T07:32:09Z | |
dc.date.issued | 2023 | |
dc.identifier.uri | http://erepository.uonbi.ac.ke/handle/11295/164592 | |
dc.description.abstract | Introduction: The definition and diagnosis of death has become more complicated because of
the advancement in critical care medicine especially advanced respiratory and cardiac support.1
Early on, death was only diagnosed with the cessation of cardiorespiratory activity. It was noted
however that some patients who had sustained fatal brain injury would remain in irreversible
coma despite respiratory system being supported by MV.1 The Concept of Brain Death thus was
born. In developed countries, there has been a concerted effort to more clearly define the concept
and develop guidelines on its diagnosis. Advance in transplant medicine and advantages of
deceased donors have contributed the need for stronger legislative regulations. This study has
reviewed the practice in KNH, identified gaps in practice and recommended a standardized
protocol for DNC.2
Study Title: Death by Neurological Criteria: A review of diagnostic practice, aimed at proposal
of a standardized protocol at KNH
Study Design: Descriptive Cross-Sectional
Broad Objective: To review the practice of determining Death by Neurological Criteria at KNH
Study Area: Critical Care Units in KNH
Study Population: All patients diagnosed with BD in KNH during the study
Sample Size: Thirty eight patients
Data Collection: Used a Data collection tool developed from AAN/AAP checklist on
diagnosing BD
Data Analysis: SPSS v29.0 Used. Univariate analysis was done using Measures of central
tendency & dispersion. Bivariate analysis using Chi-Square and Fishers Exact Test, ANOVA.
Study Results: During the study period (July-December 2022), a 38 patients were recruited into
the study. Age range was 9 months to 82 years with a mean and median of 41 years. Adults were
84%. Patients were distributed in 6 CCUs, with Main CCU having 18 (47%). The initial DNC
exam was done > 24hours after severe TBI or a CPR event, for all patients and all had acceptable
inter-exam interval for age. All patients had a pre-exam GCS of 2T and had a radiologically
confirmed cause of irreversible coma. Severe TBI was the commonest cause of Coma (44.7%)
Co-morbidities were noted to contribute negatively to the disease process of the patient.
Confounders to BD evaluation accounted for included: Temperature, Blood pressure, CNS
Depressants and metabolic disorders. All subjects had a core temperature > 350C. About 29% of
patients had a pre-exam SBP below 2 SD age in the intial DNC exam. Prior to 1st DNC, 84% of
patients were on a CNS depressant. The figure was 52.6% for the 2nd exam. The most common
CNS depressant was Phenytoin. Drug levels were not measured prior to BD exam. Severe
metabolic disorders were noted prior 1st (39.5%) and 2nd (17%) BD exam. The commonest of
these was severe metabolic acidosis. Neurologic examination was the most consistently done
aspect of BD exam. All brainstem reflexes were done in most patients. Oculovestibular reflex
was not done in patients with otorrhea. Pupillary size varied from 4-8mm. Apnoea test was done
only 10 out of 62 exams. No documented reason was given for not doing it. Where it was done,
the standard procedure was followed. The test was aborted in 5 examinations due to bradycardia
and desaturations. No ancillary test was done for any patient. BD exams were largely done by
resident doctors especially in neurosurgery, followed by anesthesia. Post DNC diagnosis, MV
settings and medical treatment were de-escalated. Supportive care was generally maintained.
CPR was noted to have been done for all patients at asystole, inspite of BD. No deceased organ
donation was reported. No formal documentation structure or checklist for BD evaluation was
available.
Conclusion: The practice of BD evaluation in KNH is not yet standardized. Different examiners
may leave out certain sections of the exam. Some confounders were not completely corrected
prior to a few of the examinations. Apnoea test, a crucial part of the exam, was not consistently
done. Having a standardized protocol and checklist will ensure adherence to the process and
improve documentation. | en_US |
dc.language.iso | en | en_US |
dc.publisher | University of Nairobi | en_US |
dc.rights | Attribution-NonCommercial-NoDerivs 3.0 United States | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/us/ | * |
dc.title | Death by Neurological Criteria: a Review of Diagnostic Practise, Aimed at Proposal of a Standardised Protocol at Knh | en_US |
dc.type | Thesis | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |