Risk of Hypotension During Apnea Testing

Jeret, Joseph S.; Benjamin, Jeffrey L.

doi:10.1001/archneur.1994.00540180073016

Cited by 60 publications

(34 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With the oxygen catheter, the test was barely completed with a systolic pressure of 90 mm Hg. This patient had atrial fibrillation and he likely did not tolerate the severe respiratory acidosis induced by apnea (pH 7.10 and 7.14 at time of discontinuation of tests for the T-piece and CPAP, respectively) (4,22,23). In both instances, the PaCO 2 at termination was Ͼ60 mm Hg, allowing confirmation of brain death.…”

Section: Discussionmentioning

confidence: 98%

“…Hypoxemia, bradycardia, and arterial hypotension are among the common complications encountered during the performance of an apnea test (4,5,13,22,23). Although in most instances apnea testing can be properly completed with the oxygen catheter technique, reports of life-threatening complications such as pulmonary barotrauma and tension pneumothorax have raised concern about its safety (6 -8).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Lévesque

Lessard

Nicole

et al. 2006

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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

Lévesque

Lessard

Nicole

et al. 2006

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Pitfalls in performing the apnea test could be encountered in clinical practice 1,9 . A few studies using small numbers of individuals have been performed in order to standardize this method 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Cardiovascular adverse effects related to the apnea test have been reported in small series of patients, such as 30% decrease of the systemic vascular resistance, increment of the cardiac index, hypoxemia, arterial hypotension, and pulmonary hypertension 7,9,10 . Appropriate perfusion is a cardinal condition to preserve the organ function.…”

Section: Discussionmentioning

confidence: 99%

Pneumothorax and pneumoperitoneum during the apnea test: how safe is this procedure?

Saposnik

Rizzo

Deluca

2000

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

-Apnea test is a crucial requirement for determining the diagnosis of brain death (BD). There are few reports considering clinical complications during this procedure. We describe a major complication during performing the apnea test. We also analyse their practical and legal implications, and review the complications of this procedure in the literature. A 54 year-old man was admitted for impaired consciousness due to a massive intracerebral hemorrhage. Six hours later, he had no motor response, and all brainstem reflexes were negative. The patient fulfilled American Academy of Neurology (AAN) criteria for determining BD. During the apnea test, the patient developed pneumothorax, pneumoperitoneum, and finally cardiac arrest. Apnea test is a necessary requirement for the diagnosis of brain death. However, it is not innocuous and caution must be take in particular clinical situations. Complications during the apnea test could be more frequent than reported and may have practical and legal implications. Further prospective studies are necessary to evaluate the frequency and nature of complications during this practice.KEY WORDS: apnea test, brain death, pneumoperitoneum, pneumothorax, complications. Pneumotorax y pneumoperitoneo durante el test de apnea: cuán seguro es este procedimiento?RESUMEN -El test de apnea (AT) es un requerimiento esencial para el diagnóstico de muerte encefálica. Hay pocos estudios que consideren complicaciones clínicas relacionadas con este procedimiento. Describimos un paciente que desarrolló una complicación mayor mientras se efectuaba el test de apnea. Realizamos una revisión de las complicaciones relacionadas con este procedimiento en la literatura. Caso clínico: Un hombre de 54 años fue admitido por deterioro del sensorio debido a una hemorragia intracerebral. Seis horas posteriores, el paciente no tenía respuesta motora, y todos los reflejos del tronco cerebral estaban abolidos. El paciente cumplía con los criterios diagnósticos de Muerte Encefálica de acuerdo a lo establecido por la Academia Americana de Neurología. Durante el test de apnea, el paciente desarrolla súbitamente pneumotorax, pneumoperitoneo, y finalmente paro cardíaco. Conclusión: El test de apnea es un requerimiento necesario para determinar el diagnóstico de muerte encefálica. No obstante, no es un procedimiento inocuo. Complicaciones durante este procedimiento pueden ser mas frecuentes que lo reportado en la literatura y tiene implicancias prácticas y legales.PALABRAS CLAVE: test de apnea, muerte cerebral, pneumoperitoneo, pneumotorax, complicaciones.During decades, death has been defined as asystole and cessation of respiration. Brain death (BD) is the irreversible cessation of all functions of the entire brain, including the brainstem. Several

show abstract

“…Furthermore, in about 40% of cases, apnea testing induces severe hypotension (13), which is the most important secondary insult related to poor outcome (death or persistent vegetative state) in human victims of severe head trauma (14). Preservation of brain blood flow in these patients requires significantly higher levels of perfusion pressure than in other individuals (12).…”

mentioning

confidence: 99%

Implications of ischemic penumbra for the diagnosis of brain death

Coimbra

1999

Braz J Med Biol Res

View full text Add to dashboard Cite

The data reviewed here suggest the possibility that a global reduction of blood supply to the whole brain or solely to the infratentorial structures down to the range of ischemic penumbra for several hours or a few days may lead to misdiagnosis of irreversible brain or brain stem damage in a subset of deeply comatose patients with cephalic areflexia. The following proposals are advanced: 1) the lack of any set of clinically detectable brain functions does not provide a safe diagnosis of brain or brain stem death; 2) apnea testing may induce irreversible brain damage and should be abandoned; 3) moderate hypothermia, antipyresis, prevention of arterial hypotension, and occasionally intra-arterial thrombolysis may contribute to good recovery of a possibly large subset of cases of brain injury currently regarded as irreversible; 4) confirmatory tests for brain death should not replace or delay the administration of potentially effective therapeutic measures; 5) in order to validate confirmatory tests, further research is needed to relate their results to specific levels of blood supply to the brain. The current criteria for the diagnosis of brain death should be revised. Correspondence

show abstract

Risk of Hypotension During Apnea Testing

Cited by 60 publications

References 27 publications

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

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

Pneumothorax and pneumoperitoneum during the apnea test: how safe is this procedure?

Implications of ischemic penumbra for the diagnosis of brain death

Contact Info

Product

Resources

About