a survey of american neurologists about brain death understanding the conceptual basis and diagnostic tests for brain death美国神经学家对脑死亡的调查了解脑死亡的概念基础和诊断测试.pdfVIP

Joffe et al. Annals of Intensive Care 2012, 2:4 /content/2/1/4 RESEARCH Open Access A survey of American neurologists about brain death: understanding the conceptual basis and diagnostic tests for brain death 1,2* 1 1 1 Ari R Joffe , Natalie R Anton , Jonathan P Duff and Allan deCaen Abstract Background: Neurologists often diagnose brain death (BD) and explain BD to families in the intensive care unit. This study was designed to determine whether neurologists agree with the standard concept of death (irreversible loss of integrative unity of the organism) and understand the state of the brain when BD is diagnosed. Methods: A previously validated survey was mailed to a random sample of 500 board-certified neurologists in the United States. Main outcomes were: responses indicating the concept of death that BD fulfills and the empirical state of the brain that would rule out BD. Results: After the second mailing, 218 (44%) surveys were returned. Few (n = 52, 27%; 95% confidence interval (CI), 21%, 34%) responded that BD is death because the organism has lost integrative unity. The most common justification was a higher brain concept (n = 93, 48%; 95% CI, 41%, 55%), suggesting that irreversible loss of consciousness is death. Contrary to the recent President’s Council on Bioethics, few (n = 22, 12%; 95% CI, 8%, 17%) responded that the irreversible lack of vital work of an organism is a concept of death that the BD criterion may satisfy. Many responded that certain brain functions remaining are not compatible with a diagnosis of BD, including EEG activity, evoked potential activity, and hypothalamic neuroendocrine function. Many also responded that brain blood flow and lack of brainstem destruction are not compatible with