Efficacy of a T-piece system and a continuous positive airway pressure system for apnea testing in the diagnosis of brain death*

Lévesque, Simon; Lessard, Martin; Nicole, Pierre; Langevin, Stéphan; LeBlanc, Francois; Lauzier, François; Brochu, Jacques G.

doi:10.1097/01.ccm.0000215114.46127.da

Cited by 74 publications

(44 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Tpiece systems used to provide oxygen via standard corrugated tubing connected to 100% oxygen at a flow of 12 L/ min have been shown to be as effective as the previously described oxygen cannula technique. 19 This method of apnea testing may theoretically be safer than the intratracheal catheter method, since the possible risk of increased intrathoracic pressure or pneumothorax would be lower. The investigators further modified their T-piece approach with corrugated tubing technique, with a 10 cm H 2 O CPAP valve attached to the distal extremity of the T-piece extension to enhance oxygenation.…”

Section: Methods Of Performing Apnea Testingmentioning

confidence: 99%

“…The investigators further modified their T-piece approach with corrugated tubing technique, with a 10 cm H 2 O CPAP valve attached to the distal extremity of the T-piece extension to enhance oxygenation. 19 Additional methods that allow the patient to stay connected to a mechanical ventilator circuit until the final phase of the apnea testing have been described. In one method, hypoventilation is achieved by reducing the minute ventilation to a low level and keeping the patient on the ventilator until the required PaCO 2 is attained.…”

Section: Methods Of Performing Apnea Testingmentioning

confidence: 99%

See 1 more Smart Citation

Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature

et al. 2013

View full text Add to dashboard Cite

The diagnosis of brain death is a complex process. Strong knowledge of neurophysiology and an understanding of brain death etiology must be used to confidently determine brain death. The key findings in brain death are unresponsiveness, and absence of brainstem reflexes in the setting of a devastating neurological injury. These findings are coupled with a series of confirmatory tests, and the diagnosis of brain death is established based on consensus recommendations. The drive to breathe in the setting of an intense ventilatory stimulus (ie, respiratory acidosis) is a critical marker of brainstem function. As a consequence, apnea testing is an important component of brain death assessment. This procedure requires close monitoring of a patient as all ventilator support is temporarily removed and PaCO 2 levels are allowed to rise. A "positive" test is defined by a total absence of respiratory efforts under these conditions. While apnea testing is not new, it still lacks consensus standardization regarding the actual procedure, monitored parameters, and evidencebased safety measures that may be used to prevent complications. The purpose of this report is to provide an overview of apnea testing and discuss issues related to the administration and safety of the procedure.

show abstract

Section: Methods Of Performing Apnea Testingmentioning

confidence: 99%

Section: Methods Of Performing Apnea Testingmentioning

confidence: 99%

Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature

et al. 2013

View full text Add to dashboard Cite

show abstract

“…ETT/O 2 C ratio was calculated by dividing an internal diameter of ETT with an external diameter of O 2 C. Twelve kinds of ETT/O 2 C ratio were resulted with this formulation. Other variables Levésque et al 2006). In the hypoventilation and CPAP methods the patient is not disconnected from mechanical ventilator but minute ventilation volue is reduced to a very low level such as 0.5 -2 L min −1 (Lang and Heckmann 2005) or ventilation mode is changed to CPAP mode with 100% O 2 (Levésque et al 2006), respectively.…”

Section: Methodsmentioning

confidence: 99%

The Safe Limits of Mechanical Factors in the Apnea Testing for the Diagnosis of Brain Death

Olguner

Koca

Akan

et al. 2007

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

“…Apnea testing could be completed in all patients with the additional use of a CPAP valve. 27 Two studies have suggested monitoring of the apnea test with transcutaneous carbon dioxide partial pressure monitoring. However, comparison with predicting PCO 2 rise using an estimated 3 mm Hg increase per minute has not been performed.…”

Section: Analysis Of Evidencementioning

confidence: 99%

Evidence-based guideline update: Determining brain death in adults

Wijdicks¹,

Varelas²,

Gronseth³

et al. 2010

Neurology

920

775

View full text Add to dashboard Cite

Objective:To provide an update of the 1995 American Academy of Neurology guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimes observed in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death?Methods: A systematic literature search was conducted and included a review of MEDLINE and EMBASE from January 1996 to May 2009. Studies were limited to adults (aged 18 years and older). Results and recommendations:In adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 American Academy of Neurology practice parameter. Complex-spontaneous motor movements and falsepositive triggering of the ventilator may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain. Neurology

show abstract

Efficacy of a T-piece system and a continuous positive airway pressure system for apnea testing in the diagnosis of brain death*

Abstract: The T-piece and the CPAP systems are effective alternatives to the standard oxygen catheter technique for apnea testing. Oxygenation was best maintained with the CPAP system, which can be useful in some patients.

Cited by 74 publications

References 20 publications

Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature

Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature

The Safe Limits of Mechanical Factors in the Apnea Testing for the Diagnosis of Brain Death

Evidence-based guideline update: Determining brain death in adults

Contact Info

Product

Resources

About