Analysis of the Incidence of Brain Death per Functioning Ventilator in the Intensive Care Units of a General Hospital

Background The identification of all brain deaths that occur in a hospital is the key point to optimize the donation process. The most common quality indicators of brain death identification refer to the total of deaths in the hospital or in the Intensive Care Units. As patients in brain death are necessarily connected to a ventilator, we have studied the number of brain dead identify per functioning ventilator. Methods Our hospital has 1314 beds and several ICUs: medical and post-surgical long stay ICU, polytrauma ICU, post-surgical short stay ICU, cardiac (coronary and cardiac surgery) ICU, and pediatric and neonatal ICUs. The following variables were identified during a year period in each ICU: the number of ventilators with 100% occupancy, the total number of deaths recorded, the number of brain deaths diagnosed, and the number of effective donors. Results In our hospital, between one and three brain deaths can be identified per each functioning ventilator/year in polytrauma, medical and cardiac ICUs. These figures were substantially lower when we analyzed post-surgical short stay ICU and pediatric and neonatal ICUs. Results are shown in table 1. Conclusions These indicators of brain death identification per functioning ventilator can be especially useful in areas of population with shortage of ventilators, in which many patients with pathology susceptible to developing brain death cannot receive respiratory support with ventilators. In these areas, the brain death identification indicators per total mortality in the hospital or ICU are expected to be low, contrary to the indicators referring to functioning ventilators. Of special interest is our analysis of the donation process in the different areas of intensive units, to clarify the best standards in the identification of brain deaths.