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Relatives May Benefit From Watching Brain Stem Death Tests

Allowing relatives to be present during testing of a patient for brain stem death can help them understand that death has occurred, difficult though it may be.

This is the finding of researchers at the Intensive Care Unit, South Cleveland Hospital, Middlesborough, England, and the University of Middlesborough in a survey of 116 consultant physicians and 129 senior nurses who work in neurotrauma intensive care units.

Overall, only 37 of the consultants and 54 of the nurses who were questioned around the country had experience of relatives' presence during testing, but 69 percent of them felt that this had helped the relatives.

Researchers point out, "In brain stem death, where the body remains warm and pink and has a pulse and a chest that rises and falls, relatives may have difficulty accepting that the patient has died. However, they warn, "the problems associated with the presence of relatives at testing for brain stem death should not be underestimated."

Clinicians with the intensive care unit occasionally allow relatives to observe testing for brain stem death because it may help some families to understand that the patient has died. "As there is no evidence to support or refute this practice, we undertook a survey to establish current practice in intensive care units in the United Kingdom."

Nurses (84 percent) were more likely than doctors (53 percent) to believe that witnessing the tests would help relatives to accept that the patient had died, and 48 percent thought that relatives may gain comfort from being present during testing.

Major potential problems appeared to be spinal reflexes by the patients and the obvious distress of the relatives.

Researchers note that "public confusion remains between brain stem death and the 'persistent' (not 'permanent') vegetative state, when patients rarely regain consciousness."

In addition, "relatives observing testing must be capable of understanding the importance of the apnea test and that movements that seem purposeful and involve the neck as well as the hands and the limbs are in fact only spinal reflexes. Continual explanation is essential."

Although only a minority of doctors and nurses invite relatives to observe testing for brain stem death, more may consider doing so in the future. "Whether this is beneficial to these families remains to be seen," the researchers concluded.
BMJ 2000;321:1505-1506. "Presence of relatives during testing for brain stem death: questionnaire study"

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