Brain death: Bilateral pneumothorax and pneumoperitoneum after an apnoea test

Théry, G; Rosman, Jérémy; Julien, G.; Chaix, F.; Mateu, Philippe

doi:10.1016/j.accpm.2018.04.004

Cited by 3 publications

(4 citation statements)

References 4 publications

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“…Pneumothorax, pneumomediastinum, and pneumoperitoneum are rare complications of AT [44]. The most common risk is barotrauma if the cannula has a diameter close to that of the endotracheal tube (ETT), and O 2 outflow is obstructed, like in a case of insertion of a 7.0 oxygen tube at 6 L/min inside a 7.5 endotracheal tube [45].…”

Section: Pneumothorax Pneumomediastinum and Pneumoperitoneummentioning

confidence: 99%

Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review

2020

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Apnea is one of the three cardinal findings in brain death (BD). Apnea testing (AT) is physiologically and practically complex. We sought to review described modifications of AT, safety and complication rates, monitoring techniques, performance of AT on extracorporeal membrane oxygenation (ECMO), and other relevant considerations regarding AT. We conducted a systematic scoping review to answer these questions by searching the literature on AT in English language available in PubMed or EMBASE since 1980. Pediatric or animal studies were excluded. A total of 87 articles matched our inclusion criteria and were qualitatively synthesized in this review. A large body of the literature on AT since its inception addresses a variety of modifications, monitoring techniques, complication rates, ways to perform AT on ECMO, and other considerations such as variability in protocols, lack of uniform awareness, and legal considerations. Only some modifications are widely used, especially methods to maintain oxygenation, and most are not standardized or endorsed by brain death guidelines. Future updates to AT protocols and strive for unification of such protocols are desirable.

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Section: Pneumothorax Pneumomediastinum and Pneumoperitoneummentioning

confidence: 99%

Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review

2020

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“…The patient's decompensation during the apnea test was due to bilateral pneumothoraces with tension physiology. There are previous case reports describing pneumothorax as a rare complication of the apnea test [1][2][3][4] with an estimated incidence of less than 0.8%. [5][6][7] Although pneumorthorax as a complication of the apnea test has been described in an adolescent patient, reports of infants with this complication are rare.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Pneumothoraces in a 3-Month-Old Infant During an Apnea Test in the Diagnosis of Brain Death

et al. 2021

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We present the case of a 3-month-old boy who suffered bilateral pneumothoraces secondary to insufflation of oxygen into the endotracheal tube during the apnea test as part of brain death testing. Although rare, awareness of this potential complication of the apnea test is of particular importance in pediatric patients who have narrow endotracheal tubes, as resistance to expiratory flow increases exponentially as lumen diameter decreases.

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“…One component of brain death diagnosis, apnea testing, is an indispensable part of the diagnostic process. Despite its crucial value, apnea testing can cause many complications including cardiac arrest [2,3]. Besides, the diagnosis of brain death by apnea testing in ECMO patients involves a difficult and complex process.…”

Section: Discussionmentioning

confidence: 99%

“…Although apnea testing application is determined with a standard protocol, there are many modified tests which is used different methods in the literature. During apnea testing, many unwanted complications might occur, at varying levels, such as hypoxia, hypotension, barotrauma, pneumothorax, and cardiac arrest [2,3]. For all these reasons, apnea testing should be performed after optimum conditions are met and the patient should be closely monitored.…”

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confidence: 99%

An approach to diagnosing brain death in patients undergoing extracorporeal membrane oxygenation

Altınsoy

Akkuş

Çatalca

et al. 2020

The European Research Journal

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Objectives:This study was intended to discuss the process of brain death diagnosis of patients undergoing extracorporeal membrane oxygenation (ECMO) and our approach regarding the existing literature. Methods: Demographics data (age, gender, admission diagnosis) were noted. ECMO type applied (venovenous or veno-arterial), time of diagnosing brain death (the time from admission time till diagnosis), being a donor or not, apnea testing application, supplementary tests applied at diagnosis stage (cerebral angiography, computerized tomography angiography, electroencephalography, transcranial doppler ultrasonography), and time of cardiac death (the time elapsing from the moment of brain death diagnosis till cardiac arrest) were noted. Results: Forty-two patients data were exaimed and ECMO was applied to 8 patients, 4 of whom are female and the others are male. The average age of the patients is 61.8 ± 9.8 years. The average time elapsing from the hospitalization till brain death diagnosis was 2.5 ± 0.5 days. Apart from that, only 2 (25%) of the patients were donors. Conclusions: The use of modified apnea testing on patients undergoing ECMO could be proliferated if such tests are standardized and reliable guidelines are set. For this reason, we think that cerebral angiography should be kept in mind in addition to apnea test especially on ECMO-treated patients.

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Brain death: Bilateral pneumothorax and pneumoperitoneum after an apnoea test

Cited by 3 publications

References 4 publications

Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review

Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review

Bilateral Pneumothoraces in a 3-Month-Old Infant During an Apnea Test in the Diagnosis of Brain Death

An approach to diagnosing brain death in patients undergoing extracorporeal membrane oxygenation

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