Ewolucja próby bezdechu w rozpoznawaniu śmierci mózgu

Abstract

The concept of brain death (BD) was initially described in 1959 and subsequently became widely accepted in the majority of countries. Nevertheless, the diagnostic guidelines for BD markedly differ, especially regarding the apnoea test (AT), a crucial element of clinical BD confirmation. The current basic guidelines recommend preoxygenation rather than disconnection from the ventilator and insertion of an oxygen insufflation catheter into the endotracheal tube. Although a properly prepared and conducted AT is relatively safe, it has to be aborted in cases of serious disturbances, such as severe cardiac arrhythmia, cardiac arrest, hypotension, hypercarbia, desaturation and tension pneumothorax. These complications may be more frequent in patients with previously existing risk factors, such as poor oxygenation, severe acidosis, hypotension and cardiac rhythm disturbances. Airway injuries can occur if the insufflation catheter is placed too deep or catheter-related obstruction of the intubation tube occurs. It is widely accepted that AT should be performed as the very last BD diagnostic procedure due to its possible lethal consequences. Reports concerning the possible pitfalls of AT and confounding situations have inspired attempts to determine the most effective and safe method of AT. The use of CPAP with oxygen supplementation is becoming highly popular. CPAP can be generated in three manners: directly by the ventilator; through the use of a CPAP valve with a reservoir; and through the use of a highly traditional T-piece system with a reservoir bag connected to distal tubing immersed in water.

Comparison of Two Apnea Test Methods, Oxygen Insufflation and Continuous Positive Airway Pressure During Diagnosis of Brain Death: Final Report

“…In the current study, the two AT methods were compared and the hypothesis regarding the negative impact of I-AT on pulmonary function was verified using a larger group of patients prior to the planned recommendation of a safer alternative, CPAP-AT, for the currently revised Polish BD criteria [16]. …”

Invitation to participate in a multi-center study for validation of cerebral computed tomography angiography and computed tomography perfusion in the determination of cerebral circulatory arrest during brain death/death by neurological criteria diagnosis procedure in paediatric population below 12 years of age

“…The research group from the Pomeranian Medical University in Szczecin was involved in scientific projects concerning BD/DNC diagnosis and legis-lation since the implementation of the first Polish BD criteria in 1984. Our main fields of interest concerned reliability and safety of various methods of apnoea test [5][6][7] as well as investigation of new techniques for CCA diagnosis [4,8,9].…”