Ethical and medical management of a pregnant woman with brain stem death resulting in delivery of a healthy child and organ donation.

Maternal brain death during pregnancy remains an exceedingly complex situation that requires not only a well-considered medical management plan, but also careful decision-making in a legally and ethically delicate situation. Management of brain dead pregnant patients needs to adhere to special strategies that support the mother in a way that she can deliver a viable and healthy child. Brain death in pregnant women is very rare, with only a few published cases.

Positive end-expiratory pressure lung recruitment: comparison between lower inflection point and ultrasound assessment.

Background: Maintenance of the open lung alveoli in the expiration on mechanical ventilation in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) remains challenging despite advances in lung imaging. The inspiratory lower inflection point (LIP) on the ventilator pressure-volume (P-V) curve estimates the required end-expiratory pressure for recruitment of alveolar consolidation. Alternatively, the end-expiratory pressure for recruitment of crater-like subpleural alveolar consolidation could be simply followed with ultrasound.

Constant cardiac output monitoring using the PiCCO and LiDCO methods versus PAK in septic patients: when to do calibration?

The accuracy of cardiac output measurement by two most widely used methods of less invasive hemodynamic monitoring and by the standard technique of thermodilution with pulmonary catheter was assessed. The measurements were carried out in septic surgical patients immediately after and between system calibrations. Study results showed satisfactory compatibility of measurements performed by the two methods and by pulmonary catheter in both phases, thus system calibration being recommendable in hemodynamically unstable septic patients.

Organ donation from a patient with bacterial meningoencephalitis -- the first case in Croatia.

The growing number of patients with terminal organ failure waiting for transplantation and the limited number of available organs demand that explantation teams see brain-dead patients with infectious diseases such as bacterial meningoencephalitis as potential donors, although until recently organ explantation from such donors has been contraindicated. This paper presents the first case of successful organ explantation from a donor with confirmed bacterial meningoencephalitis in our country. In this previously healthy patient (only with mild arterial hypertension in personal history), bacterial meningoencephalitis caused fulminant worsening and he deteriorated from mild disorder of consciousness (GCS 12) to brain death within only 24 hours.

Anesthetic management of patients undergoing pituitary surgery.

Pituitary tumors account for more than 10% of all intracranial tumors. They often present with symptoms of hormonal hypersecretion, although they may also cause hypopituitarism. Transsphenoidal pituitary surgery has become a commonly performed neurosurgical procedure, which has certain challenges for the anesthesiologist due to many distinct comorbidities associated with various adenomas.

Ultrasonographic finding of lung sliding in patients on mechanical ventilation with alveolar-interstitial syndrome.

Background And Objectives: To determine the visibility of pleural lung sliding in alveolar-interstitial syndrome (AIS) in patients on mechanical ventilation at two different time points, as a confirmatory ultrasonographic method for excluding pneumothorax.

Methods: Fifty-two mechanically ventilated patients in the semirecumbent position in a surgical/neurosurgical intensive care unit with ultrasonographic lung 'comet tails' in three upper anterolateral intercostal spaces, indicating the presence of AIS, were scanned for lung sliding in the same three intercostal spaces with a linear 5-10 MHz transducer after starting mechanical ventilation and on weaning trials. Pneumothorax and atelectasis were excluded by chest radiograph.

Transcranial Doppler in brain death confirmation in clinical practice.

Purpose: Transcranial Doppler (TCD) can be used as a confirmatory test in brain death. The aim was to present the usefulness of TCD in brain death confirmation.

Materials And Methods: Forty-four patients with severe brain lesions leading to brain death were treated over a 4-year period.

[Usefulness of transcranial Doppler in brain death confirmation].

Brain death is a clinical diagnosis and must be confirmed by one paraclinical test. This report presents the usefulness of paraclinical tests applied during a 4-year period. Forty-four patients with severe brain lesions leading to brain death were treated during the 2004-2007 period.

Increased donor rate at Sestre milosrdnice University Hospital.

The rate of organ donation reflects the level of the respective society and country development. In Croatia, attempts have been made to increase this rate. As a consequence, the number of potential donors with confirmed brain death was observed to have steadily increased during the 2004-2008 period.

Plasma interleukin-8 as a potential predictor of mortality in adult patients with severe traumatic brain injury.

Because of complex pathophysiology and severe consequences, traumatic brain injuries (TBI) are an important medical problem. Pathophysiology of TBI includes local and systemic stress response, in which interleukin-8 (IL-8) is considered as a key mediator of neuroinflammation. However, prognostic relevance of IL-8 measurement in adult patients with severe TBI is not certain.

Tocolysis with ritodrine worsens cerebral oedema in a patient with brain injury.

In a 33-weeks pregnant patient with a head injury, neurological status severely deteriorated after introduction of tocolytic treatment with ritodrine. On admission to the intensive care unit she scored 10 points on the Glasgow coma scale. She gradually recovered and on day 7 there was no neurological deficit, apart from slight confusion.

The effect of implementation of guidelines for the management of severe head injury on patient treatment and outcome.

The authors retrospectively analysed two groups of consecutive patients who were similarly matched for brain injury severity. From a total of 39 severe head injury patients, 23 were treated according to the Guidelines for the Management of Severe Head Injury with intracranial pressure (ICP) monitoring ("Guidelines group"). Such an approach allowed the maintenance of ICP within normal values, especially in patients with intraventricular ICP monitoring allowing the release of cerebrospinal fluid (CSF) from the ventricular system.

[Recent modalities in the treatment of severe head injuries].

Intracranial pressure (ICP) monitoring represents today a critical point in the treatment of patients with severe head injuries. Medical therapy depends on the intracranial pressure level. The most important in therapy is to maintain the cerebral prefusion pressure at the level of 70 mmHg or above.

Clinical course in 52 severely wounded patients treated in the intensive care unit during the war in Croatia.

Fifty-two severely wounded patients, admitted directly from a battlefield or after surgical treatment in a war hospital, were treated in the Surgical Intensive Care Unit of the 'Sisters of Mercy' University Hospital in Zagreb during the 1991 war in Croatia. Considering the severity of the wounds, blood loss was not as severe as expected. This can be attributed to the nature of the injuries as most of the patients were wounded by fragments of explosive devices which cause less tissue destruction than military bullets.

Comparison of the postoperative fibrinogen, alpha-1-antitrypsin and alpha-2- macroglobulin concentrations in the blood of wounded soldiers of Croatian Army and peacetime injured civilians.

In 10 wounded Croatian Army soldiers and in 10 civilians with accidental musculosceletal traumatisation, blood concentrations of the 3 acute phase proteins: fibrinogen, alpha-1-antitrypsin and alpha-2-macroglobulin on the 1st, 5th and 10th postoperative day were assessed. On the 5th day after injury, increased concentrations of all 3 acute phase proteins (APP) were found in all patients. The rise of the fibrinogen concentrations in the wounded soldiers was the steepest.

Hyperdynamic beta-adrenergic syndrome among Croatian soldiers engaged in battle.

A group of 1592 male Croatian soldiers (average age 32 +/- 9, ranging from 19 to 54) were examined by an internist at the war hospital. Elevated blood pressure was found in 80 men (5%); 61 of them had no history of hypertension (Group A), while in 19 patients hypertensive disease had been diagnosed before (Group B). In group A, systolic blood pressure (BPS in mm Hg), diastolic blood pressure (BPD in mm Hg) and heart rate (HR) were 182 +/- 13, 111 +/- 10, and 115 +/- 9; in group B, the values were 184 +/- 12, 108 +/- 8, 85 +/- 11.