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NDT Case study Paediatric - H

NDT Case study Paediatric - H. Bethan Thomas Specialist Nurse – Organ Donation. Background. PEG fed- no swallow Previous abdominal compartment syndrome with bowel ischaemia leading to bowel resection Worsening T2RF (normal pCO2 10-14 reported by paediatrician) Recurrent LRTI Home O2

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NDT Case study Paediatric - H

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  1. NDT Case studyPaediatric - H Bethan Thomas Specialist Nurse – Organ Donation

  2. Background • PEG fed- no swallow • Previous abdominal compartment syndrome with bowel ischaemia leading to bowel resection • Worsening T2RF • (normal pCO2 10-14 reported by paediatrician) • Recurrent LRTI • Home O2 • Recent discharge from hospital after admission for chest infection • 10 yr old • Cerebral Palsy • Global developmental delay • Microcephaly • Epilepsy • Scoliosis • Quadriplegia

  3. Day 4 BSDT Preconditions • CVS stable on noradrenaline and dopamine • BP map 66 • pCO2 8.95 pO2 49.5 • pH 7.41 • GCS 3 - unsedated • Temp 39ºC (>24 hours) • Lab results: Na 153 K+ 3.2 PO4 1.12 Mg 0.69

  4. Day 4 • Pupils 2mm-fixed • BSDT started- breathed during apnoea test • Test done by 2 PICU consultants • 2nd set not done.

  5. Day 5 BSDT Preconditions • CVS stable on noradrenaline and dopamine • BP map 80 • pH 7.33 • pCO2 8.52 pO2 19.3 • GCS 3 - unsedated • Temp 38.7ºC (>24 hours) • Lab results: Na 173 K+ 3.1 PO4 1.36 Mg 0.79

  6. Day 5 Repeat BSDT ‘Gasped’ at the end of the second set of tests.

  7. Parents given the option of withdrawing treatment after these tests

  8. Day 6 BSDT Preconditions • CVS stable on noradrenaline and dopamine • BP map 65 • pH 7.36 • pCO2 7.04 pO2 23.2 • GCS 3 - unsedated • Temp 36.8ºC (>24 hours) • Lab results: Na 160 K+ 3.7 PO4 0.8 Mg 0.94

  9. Day 6 • Third set of BSDT were performed • H breathed on the first set but after a prolonged time off the ventilator (around 7 minutes)

  10. Outcome • Parents at this time were told that neurological death was now very unlikely to occur due to the amount of time past since her hypoxic event. • H’s parents remained positive about organ donation and proceeded as a DCD saving 4 lives.

  11. Discussion points • No CT scan was done. Known aetiology was history and clinical presentation. EEG day 2- very low amplitude with no convincing cerebral activity • H was a known CO2 retainer with normal CO2 sitting around 10-12 kPa and prior to admission 12-14 kPa • H’s usual oxygen levels on facemask of 1l SaO2 >95% and on 2l via nasal cannulae >90%

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