Pneumothorax as a Complication of Apnea Testing for Brain Death

Gorton, Lauren Elizabeth; Dhar, Rajat; Woodworth, Lindsey; Anand, Nitin; Hayes, Benjamin; Ramiro, Joanna; Kumar, Abhay

doi:10.1007/s12028-016-0299-x

Cited by 9 publications

(2 citation statements)

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“…Eight of ten (80%) patients had an O 2 flow rate ≥ 8 L/min. Pneumothorax was treated to resolution in the majority of patients, although only six completed AT and only three patients became organ donors [51]. Complications can also occur as a result of direct airway [52] or tracheal [53] perforation by the supplemental oxygen cannula.…”

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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“…Apnea testing is an integral component of the determination of death by neurological criteria, also known as brain death [1]. However, removing a brain-injured patient from a ventilator can be associated with serious complications [2][3][4]. Speci cally, lack of ventilation for several minutes promotes alveolar de-recruitment and lung atelectasis, resulting in hypoxemia.…”

Section: Introductionmentioning

confidence: 99%

A Recruitment Maneuver After Apnea Testing Improves Oxygenation and Reduces Atelectasis in Organ Donors After Brain Death

Dhar,

Braun,

Kumar

et al. 2024

Neurocrit Care

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Background and PurposeHypoxemia is the main modi able factor preventing lungs from being transplanted from organ donors after brain death (BD). One major contributor to impaired oxygenation in brain-injured patients is atelectasis. Apnea testing (AT), an integral component of BD declaration, promotes atelectasis and can worsen hypoxemia. In this study, we tested whether performing a recruitment maneuver (RM) after AT could mitigate hypoxemia and radiographic atelectasis. MethodsDuring the study period, an RM (PEEP of 15 cm H 2 O for 15 seconds then 30 cm H 2 O for 30 seconds) was performed immediately after AT. We measured PaO 2 before and after RM. The primary outcomes were oxygenation (PaO 2 :FiO 2 ratio, PFR) and the severity of atelectasis (proportion of lung without aeration on CT scans after BD, quanti ed using an image analysis algorithm) in those who became organ donors.Outcomes in RM cases were compared to controls undergoing AT without RM in the two years prior. ResultsRM was performed in 54 cases after AT, with a median immediate increase in PaO 2 of 63 mm Hg (IQR 0-109, p = 0.07). Eighteen RM resulted in hypotension but none were life-threatening. Of this cohort, 37 became organ donors, who were compared with 37 donors who had AT without RM. PFR was higher in the RM group (355 ± 129 vs. 288 ± 127, p = 0.03), and fewer had hypoxemia (PFR < 300: 22% vs. 57%, p = 0.04) at the start of donor management. The RM group showed less radiographic atelectasis (median 6% vs. 13%, p = 0.045). Although there was no difference in lungs transplanted (35% vs. 24%, p = 0.44), both better oxygenation and less atelectasis on arrival were associated with a higher likelihood of lungs being transplanted. ConclusionRM after AT results in immediate improvement in oxygenation and reduces hypoxemia and atelectasis in organ donors after BD. This effect may translate into more lungs being transplanted.

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Declaring Brain Death

Wijdicks

2021

Examining Neurocritical Patients

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Pneumothorax as a Complication of Apnea Testing for Brain Death

Abstract: Development of PAT may adversely affect the process of BD determination and could limit the opportunity for organ donation. Each institution should have preventive measures in place.

Cited by 9 publications

References 11 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

A Recruitment Maneuver After Apnea Testing Improves Oxygenation and Reduces Atelectasis in Organ Donors After Brain Death

Declaring Brain Death

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