Prolonged duration of apnea test during brain death examination in a case of intraparenchymal hemorrhage

Nattanmai, Premkumar; Newey, Christopher R.; Singh, Ishpreet; Premkumar, Keerthivaas

doi:10.1177/2050313x17716050

Cited by 3 publications

(5 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other, single case modifications aimed at improved oxygenation and/or ability to conduct and complete AT described a pre-AT recruitment maneuver with incremental titration of PEEP and maintenance of PEEP via a CPAP valve [30], prolonged AT for 110 min due to suspected cardiac ventilations resulting in a very slow increase in carbon dioxide levels [31] and successful use of prone positioning with CPAP and T-piece in a severely hypoxic patient [32].…”

Section: Augmentation Of Oxygenationmentioning

confidence: 99%

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

2020

View full text Add to dashboard Cite

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.

show abstract

Section: Augmentation Of Oxygenationmentioning

confidence: 99%

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

2020

View full text Add to dashboard Cite

show abstract

“…This discrepancy could be attributed to the inverse relationship between the mean P aCO 2 increase and apnea testing duration. The precise P aCO 2 increase appears to be nonlinear 5 and unpredictable. 7 Another report identified possible variations in the P aCO 2 increase and stated that it was associated with factors including baseline P aCO 2 , oxygen flow delivery, and body temperature.…”

Section: Discussionmentioning

confidence: 99%

“…During most brain death assessments, apnea testing is completed within 8-10 min. 5,6 However, the Summary of Verification Meeting on Cases of Organ Donation under Brain Death from the Japanese MHLW (https://www.mhlw.go.jp/seisakunitsuite/ bunya/kenkou_iryou/kenkou/zouki_ishoku/dl/200_matome. pdf, Accessed March 1, 2020) indicates that apnea testing is typically completed within 6 min (mean duration ¼ 5.7 min).…”

Section: Discussionmentioning

confidence: 99%

“…7 Another report identified possible variations in the P aCO 2 increase and stated that it was associated with factors including baseline P aCO 2 , oxygen flow delivery, and body temperature. 5 Among these factors, oxygen flow delivery is usually fixed at 6 L/min. In the formula we developed, the increase ratio of the P aCO 2 was defined as the P aCO 2 value at the end of the testing period divided by the baseline P aCO 2 .…”

Section: Discussionmentioning

confidence: 99%

“…However, apnea testing duration seems unpredictable. [4][5][6][7] Calculating the increase in P aCO 2 during apnea testing could allow for greater control and a shorter testing period, thus improving patient safety. However, this topic has not been studied.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prediction of Apnea Testing Duration to Ensure Safety During Brain Death Assessment

2021

View full text Add to dashboard Cite

BACKGROUND: Apnea testing is the last step of brain death assessment. This study aimed to determine whether apnea testing is safer when performed over a shorter duration. METHODS: The medical records of 200 brain-dead donors were retrospectively evaluated. All the records were anonymously registered in the Japanese Ministry of Health, Labor, and Welfare from 1999 to 2012. The rate of P aCO 2 increase was analyzed to calculate the duration required for apnea testing. RESULTS: At baseline, body temperature and P aO 2 significantly affected the increase rate of P aCO 2 . At baseline, the apnea testing durations were 4.7 min with normal body temperature and higher P aO 2 (P aCO 2 40-60 mm Hg, body temperature 36.5 C, P aO 2 400 mm Hg); further, it was 3.0 min with higher body temperature and lower P aO 2 at baseline (P aCO 2 40-60 mm Hg, body temperature 38.0 C, P aO 2 100 mm Hg). CONCLUSIONS: The specific duration of apnea testing during brain death assessment may be predicted by measuring the increase rate of P aCO 2 .

show abstract

Detection of spontaneous breathing during an apnea test in a patient with suspected brain death using electrical impedance tomography: a case report

Chen,

Lovas,

Bakos

et al. 2024

BMC Pulm Med

View full text Add to dashboard Cite

Introduction The apnea test (AT) is a crucial procedure in determining brain death (BD), with detection of spontaneous breathing efforts serving as a key criterion. Numerous national statutes mandate complete disconnection of the patient from the ventilator during the procedure to open the airway directly to the atmosphere. These regulations mandate visual observation as an exclusive option for detecting breathing efforts. However, reliance on visual observation alone can pose challenges in identifying subtle respiratory movements. Case Presentation This case report presents a 55-year-old morbidly obese male patient with suspected BD due to cerebral hemorrhage undergoing an AT. The AT was performed with continuous electrical impedance tomography (EIT) monitoring. Upon detection of spontaneous breathing movements by both visual observation and EIT, the AT was aborted, and the patient was reconnected to the ventilator. EIT indicated a shift in ventilation distribution from the ventral to the dorsal regions, indicating the presence of spontaneous breathing efforts. EIT results also suggested the patient experienced a slow but transient initial recovery phase, likely due to atelectasis induced by morbid obesity, before returning to a steady state of ventilatory support. Conclusion The findings suggest EIT could enhance the sensitivity and accuracy of detecting spontaneous breathing efforts, providing additional insights into the respiratory status of patients during the AT.

show abstract

Prolonged duration of apnea test during brain death examination in a case of intraparenchymal hemorrhage

Cited by 3 publications

References 12 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

Prediction of Apnea Testing Duration to Ensure Safety During Brain Death Assessment

Detection of spontaneous breathing during an apnea test in a patient with suspected brain death using electrical impedance tomography: a case report

Contact Info

Product

Resources

About