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April�05

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Section�Critical Care

12燘rain Failure and Brain Death
David牋Crippen,燤.D., F.C.C.M.
University of Pittsburgh School of Medicine

As a type of organ system failure, brain failure invariably affects consciousness. Altered consciousness may be categorized, on the basis of physical examination, as cloudy consciousness, lethargy, obtundation, stupor, coma, or brain death. If physical examination is inconclusive, monitoring of cerebral function may be helpful. The relation between cardiac arrest and brain failure is considered. Maintaining a small amount of blood flow to the brain with CPR is not necessarily beneficial: more brain damage seems to occur with prolonged CPR states than with no-flow states. The pathophysiology of brain failure is briefly reviewed. Definitions of death based on both cardiovascular and neurologic criteria are discussed, and the question of whether whole brain death may be considered equivalent to death is addressed. This chapter contains 46 references.


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