Critical Crossroads: Medication Management and Ethical Considerations in ICU Brain Death Management-Critical Crossroads

Video Transcription

Video Summary

This webcast, moderated by clinical pharmacy manager Judah Brown, addresses critical medication management and ethical considerations in ICU brain death determination. Dr. David Greer reviews the history, evolving guidelines, and clinical criteria for diagnosing brain death, emphasizing the importance of stringent, standardized procedures to avoid errors. The 2023 combined guidelines unify adult and pediatric criteria, stressing neuroimaging consistency, temperature and blood pressure requirements, and careful timing—especially after interventions like hypothermia or intracranial pressure treatments.<br /><br />Dr. Michael Armaheiser focuses on pharmacological confounders that can mimic brain death, including sedatives, opioids, neuromuscular blockers, and other agents like pentobarbital, baclofen, tricyclic antidepressants, and bupropion. He highlights the impact of organ dysfunction and hypothermia on drug metabolism and stresses the need for toxicology testing and therapeutic drug monitoring. Hormone therapies, such as vasopressin and glucocorticoids, are also discussed in management contexts.<br /><br />Clinical testing requires three cardinal features: coma, absent brainstem reflexes, and apnea, tested rigorously through neurological exams and apnea testing with precise protocols. Ancillary testing (preferably nuclear medicine or angiography) is reserved for cases with confounders or inability to complete clinical exams; EEG and CT angiography are discouraged due to unreliability. The webcast underscores using checklists, multidisciplinary collaboration, and updated institutional policies to ensure accurate, ethical brain death determinations, with ongoing education and research initiatives supporting best practices.

Keywords

ICU brain death determination

medication management

ethical considerations

2023 brain death guidelines

pharmacological confounders

clinical testing criteria

ancillary testing methods

therapeutic drug monitoring

multidisciplinary collaboration

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