Neuro ICU - Do you talk to brain-dead patients?

Brain dead is DEAD. Period.

I am confused as to why a brain dead patient would even be in an ICU, unless it was just long enough to allow their family to come to grips with their status, make a decision about organ donation, and let go. Yes, those families might find it comforting to "talk to" that loved one, and say their final good-byes, but--why would health care professionals do so? Pray for their souls; yes, please do, but dead people do not hear!

stephanie,

may i ask how your son is doing? and i certainly don't mean to sound glib but if alive, does he still respond to your touch, your voice?

leslie

14 years ago, after a liver transplant that went terribly wrong, my 15 y/o son was diagnosed brain dead.
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Thanks for sharing Stephanie. I had been reluctant to delv into this area but I have a bit more to add to my story seeing as you are so brave about it.

I was in a coma because I caught on fire trying to rescue my children from our burning home. I was burned over 60%.

My 4 year old died at the scene, but my 7 year old was put on life support.

I was not involved in the decision to have him removed from life support but heard about all of this next part 2nd hand.

Those involved in transplantation went to my husband wanting little Eric's organs. My husband said he wanted to talk with the Greek priest in the area first. He did. My husband came back and told them no. These same people then went to my parents and told them that my husband had agreed but they needed my parents signatures as well. My parents who were suspicious went to double check. lies. lies lies.

Another incident was that the decision to remove from life support had not been made yet. My mother-in-law who was a head nurse at another hospital noticed that the respirator had been turned way down. My husband furious called the person in charge whose response was, "well, by law we dont have to keep your child alive any more". Gee. Give my husband some time. It had been one day. one day. The respirator was then turned back up.

The point is that sometimes medical personnel can predict what the outcome will be. But sometimes they cannot. My prognosis was dying. They were wrong. Then it was I would have brain damage from lack of oxygen. I have some problems with short term memory but nothing major. Then it was I would be in a wheelchair. I am not. Then it was I would have major scarring. I have very little and you cant tell I am even burned at all.

The line between life and death is so blurry.

And sympathy to you, Stephanie. May his memory be eternal.

Brain dead is DEAD. Period.

I am confused as to why a brain dead patient would even be in an ICU, unless it was just long enough to allow their family to come to grips with their status, make a decision about organ donation, and let go. Yes, those families might find it comforting to "talk to" that loved one, and say their final good-byes, but--why would health care professionals do so? Pray for their souls; yes, please do, but dead people do not hear!

There is a huge difference between talking to a patient in coma or chronic vegetative state than talking to one that is brain-dead. Those people have a chance to "come back," and no one knows what or even if they hear-- but we hope they do, and hope that talking to them will stimulate them and help them "come back" if there is the slimmest chance to do so.

To be brain dead, an EEG has confirmed that there is no longer any electrical activity in the brain. As others have stated, the EEG can be waived--there is other diagnostic criteria, especially in the case of anoxic brain injuries. I know that sometimes just disconnecting from a ventilator for a specified time, to see if any spontaneous breathing will occur in that time, is used. In those cases, an EEG would not tell anyone anything that they do not already know.

However, often organ transplant programs require the EEG to definitively confirm brain death, probably for legal reasons. Also, that EEG report makes it a bit easier for the families to accept that, yes, this loved one REALLY IS DEAD--there will be no coming back. It's at that point that they allow themselves to let go.

The brain controls the autonomic nervous system. If a brain dead person is disconnected from a ventilator, the heart will also stop. All that was keeping that person "alive", or more accurately, his organs perfused, was that ventilator.

Thank you Kyriaka. I am sorry for your loss of your 4year year old. You didnt the the outcome of your 7year old that was put on life support. If he passed I am so sorry and know your pain. If not, how is he? And I am so glad to hear that you have very minimal deficits from your burns. God works in mysterious ways. Medical personnel ie: Doctors and nurses both can only use the information and knowledge given to them, but the final outcome is in Gods hands.

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My 7 year old passed away. I have now been single for over 10 years and always new things down the road. Although these things are not easy I can honestly say even at 37 years old that I have learned a great deal:


I never understood the handicapped, until I had a handicapped child.

I never understood what it was like to be heavy until I weighed 280 lbs.

I never understood grief until my children died.

I never understood pain until I was burned 60% in a house fire.

I never understood perseverance until I lost 150 lbs.

I never understood desperation until I was infected with Lyme Disease.

I never understood gratitude until I no longer had to take medication for Lyme.

I never understood trust until I lost my job.

And I never understood my future until I decided to go back to school to be a nurse to work critical care burns.

***
You never know what life will give you.

14 years ago, after a liver transplant that went terribly wrong, my 15 y/o son was diagnosed brain dead.
____________________
Thanks for sharing Stephanie. I had been reluctant to delv into this area but I have a bit more to add to my story seeing as you are so brave about it.

I was in a coma because I caught on fire trying to rescue my children from our burning home. I was burned over 60%.

My 4 year old died at the scene, but my 7 year old was put on life support.

I was not involved in the decision to have him removed from life support but heard about all of this next part 2nd hand.

Those involved in transplantation went to my husband wanting little Eric's organs. My husband said he wanted to talk with the Greek priest in the area first. He did. My husband came back and told them no. These same people then went to my parents and told them that my husband had agreed but they needed my parents signatures as well. My parents who were suspicious went to double check. lies. lies lies.

Another incident was that the decision to remove from life support had not been made yet. My mother-in-law who was a head nurse at another hospital noticed that the respirator had been turned way down. My husband furious called the person in charge whose response was, "well, by law we dont have to keep your child alive any more". Gee. Give my husband some time. It had been one day. one day. The respirator was then turned back up.

The point is that sometimes medical personnel can predict what the outcome will be. But sometimes they cannot. My prognosis was dying. They were wrong. Then it was I would have brain damage from lack of oxygen. I have some problems with short term memory but nothing major. Then it was I would be in a wheelchair. I am not. Then it was I would have major scarring. I have very little and you cant tell I am even burned at all.

The line between life and death is so blurry.

And sympathy to you, Stephanie. May his memory be eternal.

Those involved in transplantation went to my husband wanting little Eric's organs. My husband said he wanted to talk with the Greek priest in the area first. He did. My husband came back and told them no. These same people then went to my parents and told them that my husband had agreed but they needed my parents signatures as well. My parents who were suspicious went to double check. lies. lies lies.

Another incident was that the decision to remove from life support had not been made yet. My mother-in-law who was a head nurse at another hospital noticed that the respirator had been turned way down. My husband furious called the person in charge whose response was, "well, by law we dont have to keep your child alive any more". Gee. Give my husband some time. It had been one day. one day. The respirator was then turned back up.

The point is that sometimes medical personnel can predict what the outcome will be. But sometimes they cannot. My prognosis was dying. They were wrong. Then it was I would have brain damage from lack of oxygen. I have some problems with short term memory but nothing major. Then it was I would be in a wheelchair. I am not. Then it was I would have major scarring. I have very little and you cant tell I am even burned at all.

The line between life and death is so blurry.

That's what I thought, too, but the cases van Norman refers to are definitely patients who have been (evidently incorrectly) diagnosed as brain-dead:

"Case 1 - An anesthesiologist questioned his colleagues on the Internet about whether strict brain death criteria are relevant when the organ donor is not expected to survive his or her injuries. He reported a case in which, while caring for a multiple organ donor who had been declared brain dead after an intracranial hemorrhage, he administered a dose of neostigmine to treat an episode of tachycardia. The donor began to breathe spontaneously just as the surgeon announced that the vena cavae were ligated and the liver had been removed. Upon subsequent review of the patient's chart, the anesthesiologist learned that the donor had gasped at the end of an apnea test, but a neurosurgeon had certified that brain death criteria had been met.

Case 2
During an educational course for anesthesiologists, a participant described a case (not independently verified by the author) in which a 30-yr-old patient was admitted to a level 1 trauma center with severe head trauma. A computed tomography scan demonstrated diffuse cerebral damage and blood in the fourth ventricle. The patient was declared brain dead by two physicians, and preparations were made to obtain vital organs for transplantation. Liver transplantation was planned for a level 1 recipient: an otherwise healthy 19-yr-old with hepatic dysfunction of unknown origin.
The on-call anesthesiologist noted that the donor was intubated but breathing spontaneously with a tidal volume of 800 cm3 and a respiratory rate of 20 breaths/min. When the anesthesiologist questioned the diagnosis of brain death, one of the declaring physicians reportedly stated that because the donor was not going to recover, he/she could be declared brain dead, and that in any case the liver recipient would die imminently without transplantation. Vital organ collection proceeded over the protests of the anesthesiologist, who observed donor movement and hypertension with skin incision that required treatment with thiopental and a muscle relaxant. The liver recipient died in another operating room of acute hemorrhage before liver collection was complete. The liver went untransplanted.

Case 3
An anesthesiologist requests that his/her department review the events surrounding a potential organ collection. A young woman receiving intravenous magnesium sulfate for pregnancy-induced hypertension suffered seizures several hours after vaginal delivery. After the seizures, she was unarousable and posturing. She was intubated after intravenous administration of 4 mg pancuronium, and a computed tomography scan showed coning, diffuse edema, and occipital lobe infarcts. A neurologist determined that the patient had suffered a "catastrophic neurologic event." Intravenous esmolol that was being infused to control blood pressure and heart rate was discontinued, and permission was obtained from the patient's family for the patient to become a vital organ donor.
On the day of anticipated organ collection, the anesthesiologist found that the donor had small, reactive pupils, weak corneal reflexes, and a weak gag reflex. The esmolol infusion was reinstituted. Further review of the patient's chart showed the previous administration of pancuronium, and a serum magnesium level of 5.1 mEq/l, more than 2.5 times normal several hours after the magnesium infusion had been discontinued. After the anesthesiologist administered edrophonium 10 mg intravenously, the patient coughed, grimaced, and moved all extremities.
Vital organ collection was canceled, and after consultation with a neurosurgeon, the patient underwent placement of an intracranial pressure monitor. Intracranial pressure was initially 18 cm H2O and gradually decreased with therapy to 10 cm H2O. The patient ultimately regained consciousness and was discharged home. She was alert and oriented but suffered from significant neurologic deficits. Gail A van Norman MD A Matter of Life and Death: What Every Anesthesiologist Should Know about the Medical, Legal, and Ethical Aspects of Declaring Brain Death Anesthesiology Volume 91(1) July 1999 pp 275-287

It may very well be that these are isolated cases, but they're disturbing nonetheless.