NEUROLOGIE PRO PRAXI / Neurol. praxi. 2025;26(2):97-102 / www.neurologiepropraxi.cz 102 HLAVNÍ TÉMA História definovania a stanovenia smrti solvovať špecializovaný tréning v BD/DNC. Zároveň nemôžu byť títo lekári nijakým spôsobom spojení s transplantačným programom a odberom orgánov. Trvanie observácie je v niektorých prípadoch priamo dané etiológiou, použitými terapeutickými postupmi a vekovou kategóriou pacienta. V prípade detských pacientov sú potrebné dve klinické vyšetrenia a v skupine dospelých je potrebné jedno vyšetrenie, ale odporúča sa (nevyžaduje) aj druhé vyšetrenie iným nezávislým hodnotiteľom. Pri zistení jediného príznaku činnosti mozgu v rámci klinického vyšetrenia nie sú konfirmačné testy indikované. Osobitná pozornosť je v odporúčaniach venovaná použitiu neurozobrazovacích vyšetrení, telesnej teplote, tlaku krvi, vylúčeniu liekových a iných intoxikácií (vrátane zohľadnenia funkčnosti hepatorenálneho komplexu), ako aj metabolických, acidobázických a endokrinných porúch. Podrobne sú zmienené barbituráty a periférne myorelaxanciá. Ďalej je metodicky upresnené vykonanie apnoického testu (ako aj apnoického testu osôb na ECMO). Z konfirmačných testov sú uvedené taxatívne iba DSA (s nástrekom obidvoch karotických aj vertebrálnych tepien), perfúzny SPECT mozgu a u dospelých aj transkraniálna UZ dopplerometria. CT a MR angiografické vyšetrenia, ako aj EEG sú z procesu vylúčené. V každom prípade je možné povedať, že kritériá BD/DNC nezaznamenali v priebehu rokov väčší počet zmien a môžeme postulovať ich konzistenciu a kontinuitu (Hills, 2024). Takto nateraz končí príbeh z moderného sveta o definovaní a určovaní smrti človeka. 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New York, NY: Springer. 2008. https://doi.org/10.1007/978-0-387-72966-4_4. Obr. 6. Chronologická história ustanovenia a používania BD/DNC (Greer, Lewis et Kirschen, 2024) 1959: Mollaret & Goulon published Le Coma Dépassé, credited as the first attempt to present formal criteria for BD/DNC1 1976: Brain death guidelines issued by the UK19 1981: President’s Commission for the Study of Ethical Problems in Medicine and Blomedical and Behavioral Research on Defining Death produced the Uniform Determination of Death Act12 (UDDA) 1995: US adult guidelines Issued18 2008: Revised UK guidelines Issued by the Academy of Medical Royal Collages16 2011: Revised US paediatric guidelines Issued27 2020: International consensus statement on BD/DNC published by the World Brain Death Project4 (WBDP) 1968: Report from Ad Hoc Committee of Harvard Medical Schoolto Examine the Definition of Brain Death, which aimed to codify BD/DNC determination procedures14 1977: NIH collaborative study on the natural history of BD/DNC15 1987: US paediatric guidelines Issued17 1999: Canadian guidelines Issued20 2010: Revised US adult guidelines Issued20 2015: Revised UK adult guidelines Issued for infants under 2 months old 2023: Revised US combined paediatric and adult BD/DNC guidelines Issued5 2023: Revised Canadian BD/DNC guidelines Issued7
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