Intracranial pressure and cerebral perfusion pressure during apnoea testing for the diagnosis of brain death – an observational study

Roth, Christian; Deinsberger, W.; Kleffmann, Jens; Ferbert, A.

doi:10.1111/ene.12727

Cited by 26 publications

(27 citation statements)

References 25 publications

(40 reference statements)

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“…Hypercapnia‐induced vasodilatation has been discussed as provoking severe elevations of ICP with consecutive loss of CPP . Indeed, a (non‐significant) trend towards ICP increase during AT was reported in a recent study . As CPP was positive during BD examination in this study , increases of MAP might have accounted for elevations of ICP due to a slight net influx of blood into brain vessels.…”

Section: Discussionsupporting

confidence: 50%

“…Indeed, a (non‐significant) trend towards ICP increase during AT was reported in a recent study . As CPP was positive during BD examination in this study , increases of MAP might have accounted for elevations of ICP due to a slight net influx of blood into brain vessels. Based on this finding, we elucidated whether potential changes of ICP during AT correlated with changes of CPP levels.…”

Section: Discussioncontrasting

confidence: 43%

“…This finding is different from the data published by Roth et al . . Differences in MAP courses between the two studies might be influenced by the efforts to stabilize hemodynamic parameters during AT.…”

Section: Discussionmentioning

confidence: 96%

“…The primary goal of our study was to provide a comprehensive evaluation of neuromonitoring data and arterial blood gas analysis in patients undergoing BD determination to elucidate the safety of AT with regard to cerebral hemodynamics and cardiorespiratory physiology. Based on earlier reports , we elucidated whether changes of ICP during AT correlate with changes of CPP levels. In particular, we hypothesized that ICP increases when CPP remains positive during AT, whereas ICP should not change in patients with negative CPP.…”

Section: Introductionmentioning

confidence: 99%

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Safety of apnea testing for the diagnosis of brain death: a comprehensive study on neuromonitoring data and blood gas analysis

Salih

Hoffmann

Brandt

et al. 2019

Euro J of Neurology

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Background and purpose Here, we studied the safety of apnea testing (AT) for the determination of brain death with regard to intracranial pressure (ICP), cerebral perfusion and arterial blood gas parameters. We hypothesized that ICP only increases when cerebral perfusion pressure (CPP) remains positive during AT. Methods A total of 34 patients who fulfilled brain death criteria were identified by chart review (2009–2017). We analysed ICP, CPP and mean arterial pressure (MAP) prior to AT, during AT and after AT, as well as arterial pH, paCO2, paO2 and arterial O2 saturation at the start and end of AT. Results Intracranial pressure was 87.9 ± 17.7 mmHg (mean ± SD) prior to AT, 89.9 ± 17.2 mmHg during AT and 86.4 ± 15.2 mmHg after AT (P = 0.9). CPP was −6.9 ± 12.8 mmHg prior to AT, −7.1 ± 13.7 mmHg during AT and −8.6 ± 13.0 mmHg after AT (P = 0.98), respectively. MAP was 82.9 ± 14.6 mmHg prior to AT, 84.7 ± 13.9 mmHg during AT and 79.7 ± 9.6 mmHg after AT (P = 0.57), respectively. A total of 10 patients had positive CPP (8.6 ± 4.3 mmHg), but ICP did not increase during AT. Arterial pH decreased from 7.43 ± 0.06 to 7.22 ± 0.06 (P < 0.05), paCO2 increased from 38.6 ± 4.2 to 69.6 ± 8.0 mmHg (P < 0.05), paO2 decreased from 416.3 ± 113.4 to 289.2 ± 146.5 mmHg (P < 0.05), and O2 saturation was stable at 99.8 ± 0.4% and 98.2 ± 3.2% (P = 0.39). Conclusions Apnea testing had no detrimental effect on ICP, CPP, MAP or oxygenation, regardless of the presence of an initially positive CPP. The lack of further ICP elevations is presumably explained by critical closing pressures above individual CPP levels during AT.

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Section: Discussionsupporting

confidence: 50%

Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Safety of apnea testing for the diagnosis of brain death: a comprehensive study on neuromonitoring data and blood gas analysis

Salih

Hoffmann

Brandt

et al. 2019

Euro J of Neurology

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“…Advances in neurology occur across a broad front including neuro‐oncology, trauma, neuro‐otology and neurodevelopment. These areas also overlap with other specialist areas within the neurosciences.…”

mentioning

confidence: 99%