<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0390</journal-id>
<journal-title><![CDATA[Revista Médica del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. Urug.]]></abbrev-journal-title>
<issn>1688-0390</issn>
<publisher>
<publisher-name><![CDATA[Sindicato Médico del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-03902022000101913</article-id>
<article-id pub-id-type="doi">10.29193/rmu.38.1.12</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Dos enfoques conocidos para la determinación de muerte neurológica del adulto: propuesta de un concepto unificado]]></article-title>
<article-title xml:lang="en"><![CDATA[Two criteria to determine brain death in adults: a proposal to achieve a unified definition]]></article-title>
<article-title xml:lang="pt"><![CDATA[Morte neurológica em adulto: proposta de um conceito unificado]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cacciatori]]></surname>
<given-names><![CDATA[Armando]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Godoy]]></surname>
<given-names><![CDATA[Daniel Agustín]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Nacional de Donación y Trasplante  ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,ASSE Sanatorio Pasteur Unidad de Cuidados Neurointensivos]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2022</year>
</pub-date>
<volume>38</volume>
<numero>1</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-03902022000101913&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-03902022000101913&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-03902022000101913&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: Cuanto más progreso en el conocimiento de la injuria encefálica aguda (IEA) irreversible y su potencial evolución a la muerte encefálica (ME), existirán más posibilidades de captación de donantes, con la consiguiente disminución de las listas de espera. A nuestro criterio, el médico intensivista deberá tener presente tal posibilidad cuando se enfrenta a víctimas de neuroinjuria independientemente de su etiología. Además, resulta imprescindible que conozca la fisiopatología del síndrome de ME y los pasos a seguir para la realización de un examen neurológico completo, exhaustivo y riguroso que lo confirme. Al día de hoy, existen dos conceptos de muerte según criterios neurológicos: muerte encefálica total&#8217; (MET) y muerte de troncoencéfalo (MT). Si bien ambas definiciones son aceptadas por la comunidad médica mundial, algunos países adoptan una u otra, recibiendo el marco legal correspondiente que lo avale. Debatiremos ambos conceptos, con la intención de intentar generar un concepto unificado y consensuado de ME.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: The greater the advance in terms of knowing about acute encephalic injury (AEI) and its potential evolution to encephalic death (ED), the higher the possibilities of finding donors, with the corresponding reduction of waiting lists. As we see it, intensivists must consider this possibility whenever they face victims of neuroinjury, regardless of its etiology. In addition to this, it is essential for them to know the pathophysiology of encephalic death syndrome, and the steps to be taken for a complete, thorough and strict neurologic exam. Today, there are two criteria to determine death according to neurologic criteria: &#8220;total brain death&#8217;&#8217; (MET) and &#8216;&#8217;brainstem death&#8217;&#8217; (MT). Despite the fact that both criteria are accepted by the global medical community, some countries adopt one or the other criteria, which defines the corresponding legal framework that supports it. We will debate both criteria, aiming to achieve a unified and agreed definition of brain death.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: Quanto mais avançarmos no conhecimento da lesão encefálica aguda irreversível (IEA) e sua evolução potencial para morte encefálica (ME), maiores serão as possibilidades de captação de doadores, com a consequente redução das listas de espera. Em nossa opinião, o médico intensivista deve ter essa possibilidade em mente ao lidar com vítimas de injúria neurológica, independentemente de sua etiologia. Também é essencial que conheça a fisiopatologia da síndrome de ME e as etapas a seguir para realizar um exame neurológico completo, exaustivo e rigoroso para confirmá-la. Até o momento, existem dois conceitos de morte segundo critérios neurológicos: &#8220;morte encefálica total&#8221; (MET) e &#8220;morte encefálica&#8221; (MT). Embora ambas as definições sejam aceitas pela comunidade médica mundial, alguns países adotam uma ou outra, recebendo o respectivo arcabouço legal para apoiá-la. Discutiremos ambos os conceitos, com o intuito de tentar gerar um conceito unificado e consensual de ME.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Muerte encefálica]]></kwd>
<kwd lng="es"><![CDATA[Adulto]]></kwd>
<kwd lng="en"><![CDATA[Brain death]]></kwd>
<kwd lng="en"><![CDATA[Adult]]></kwd>
<kwd lng="pt"><![CDATA[Morte encefálica]]></kwd>
<kwd lng="pt"><![CDATA[Adulto]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<collab>Red-Consejo Iberoamericano de Donación y Trasplantes</collab>
<article-title xml:lang=""><![CDATA[Informe/Recomendación REC-RCIDT-2008(9) sobre la muerte encefálica en Iberoamérica]]></article-title>
<source><![CDATA[Newsletter]]></source>
<year>2008</year>
<volume>2</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>28-51</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Greer]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Shemie]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Lewis]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Torrance]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Varelas]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Goldenberg]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Determination of brain death/death by neurologic criteria: the World Brain Death Project]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2020</year>
<volume>324</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>1078-97</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Truog]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Krishnamurthy]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Tasker]]></surname>
<given-names><![CDATA[R.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Brain death-moving beyond consistency in the diagnostic criteria]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2020</year>
<volume>324</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>1045-7</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bernat]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Culver]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Gert]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[On the definition and criterion of death]]></article-title>
<source><![CDATA[Ann Intern Med]]></source>
<year>1981</year>
<volume>94</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>389-94</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kondziella]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The neurology of death and the dying brain: a pictorial essay]]></article-title>
<source><![CDATA[Front Neurol]]></source>
<year>2020</year>
<volume>11</volume>
<page-range>736</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Escudero Augusto]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Otero Hernández]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[La muerte encefálica]]></article-title>
<person-group person-group-type="editor">
<name>
<surname><![CDATA[Ortega]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Arias]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Campistol]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Matesanz]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Morales]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<source><![CDATA[Trasplante renal]]></source>
<year>2007</year>
<page-range>20-5</page-range><publisher-loc><![CDATA[Buenos Aires ]]></publisher-loc>
<publisher-name><![CDATA[Médica Panamericana]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wijdicks]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Determining brain death in adults]]></article-title>
<source><![CDATA[Neurology]]></source>
<year>1995</year>
<volume>45</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>1003-11</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bleakley]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Understanding brainstem death testing]]></article-title>
<source><![CDATA[Br J Neurosci Nurs]]></source>
<year>2017</year>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Correa]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Puppo]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Biestro]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Mizraji]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Cancela]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Grille]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<source><![CDATA[Muerte encefálica: actualización de Consenso de muerte encefálica en adultos]]></source>
<year>2016</year>
<edition>5</edition>
<publisher-loc><![CDATA[Montevideo ]]></publisher-loc>
<publisher-name><![CDATA[Instituto Nacional de Donación y Trasplante de Células, Tejidos y Órganos]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Webb]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Samuels]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Brain death dilemmas and the use of ancillary testing]]></article-title>
<source><![CDATA[Continuum (Minneap Minn)]]></source>
<year>2012</year>
<volume>18</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>659-68</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Escudero]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnóstico de muerte encefálica]]></article-title>
<source><![CDATA[Med Intensiva]]></source>
<year>2009</year>
<volume>33</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>185-95</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cameron]]></surname>
<given-names><![CDATA[EJ]]></given-names>
</name>
<name>
<surname><![CDATA[Bellini]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Damian]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
<name>
<surname><![CDATA[Breen]]></surname>
<given-names><![CDATA[DP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Confirmation of brainstem death]]></article-title>
<source><![CDATA[Pract Neurol]]></source>
<year>2016</year>
<volume>16</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>129-35</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Smith]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Brain death: the United Kingdom perspective]]></article-title>
<source><![CDATA[Semin Neurol]]></source>
<year>2015</year>
<volume>35</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>145-51</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
