Yoğun Bakımda Beyin Ölümü Olgusunda Donör Bakımı
Özet
57 yaşındaki kadın hasta, evde bilinç değişikliği yaşaması üzerine acil servise başvurdu ve düşük Glasgow koma skoru nedeniyle elektif entübasyon gerçekleştirildi. Beyin bilgisayarlı tomografisi (BT) ve anjiyo BT taramaları, hipertansif anevrizmatik subaraknoid kanama (SAK) ile uyumlu bulgular verdi ve hasta ileri değerlendirme ve tedavi amacıyla yoğun bakım ünitesine (YBÜ) alındı. YBÜ’de, yüksek tansiyon nedeniyle nikardipin infüzyonu başlatıldı, invaziv arteriyel tansiyon ölçümü yapıldı ve sol vertebral arterdeki anevrizmaya coil embolizasyon uygulandı. İşlem sonrasında hastanın takiplerinde Glasgow koma skoru (GKS) düşmüş, kontrol beyin BT ile mevcut tedavi sürdürülmüştür. Yaklaşık 48 saat sonra hastada beyin ölümü ön tanısı konmuş, apne testi yapılması planlanmış ancak uygun şartlar sağlanamadığı için test gerçekleştirilememiştir. Beyin ve karotis anjiyo BT sonuçlarına göre beyin ölümü tanısı konulmuştur ve organ donörü süreci başlatılmıştır. Donör bakım süreci kapsamında hastaya metilprednizolon verilmiş, glisemi takibi ve enteral beslenme devam etmiş, sıvı ve elektrolit dengesi sağlanmış ve başarılı bir şekilde hasta organ toplama işlemi için ameliyathaneye gönderilmiştir.
A 57-year-old female patient presented to the emergency department after experiencing an altered level of consciousness at home. Elective intubation was performed due to a low Glasgow Coma Scale (GCS) score. Brain computed tomography (CT) and CT angiography scans revealed findings consistent with hypertensive aneurysmal subarachnoid hemorrhage (SAH), and the patient was admitted to the intensive care unit (ICU) for further evaluation and treatment. In the ICU, nicardipine infusion was initiated to manage high blood pressure, invasive arterial blood pressure monitoring was performed, and coil embolization was applied to the aneurysm in the left vertebral artery. During follow-up after the procedure, the patient's Glasgow Coma Scale (GCS) score decreased, and the current treatment was continued based on control brain CT. Approximately 48 hours later, the patient was preliminarily diagnosed with brain death. An apnea test was planned but could not be performed due to the lack of appropriate conditions. Based on the results of brain and carotid CT angiography, a diagnosis of brain death was made, and the organ donor process was initiated. As part of the donor care process, the patient received methylprednisolone, glycemic monitoring and enteral nutrition were maintained, fluid and electrolyte balance was ensured, and the patient was successfully transferred to the operating room for organ procurement.
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