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

Abstract

The results from the study show that I-AT may compromise pulmonary function in some cases and is one of the reasons for the recommendation of a safer option, CPAP-AT, in the currently revised Polish BD criteria. During AT, the mean CO increase rate was 5 mmHg/min, which, in most patients, would allow the test to be completed after just 5 min.

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

“…The 2010 AAN guidelines and the Austrian guidelines support AT with a T-piece and CPAP (second approach) if conventional AT resulted in poor oxygenation [4,14]. Contrastingly, the Polish criteria recommend routine use of CPAP on a ventilator (CPAP-AT) [15]. These techniques can prevent the decruitment of lungs, reduce the risk of hypoxemia, and increase hemodynamic stability by prevention of blood pressure fluctuation compared to the traditional O 2 insufflation method.…”

“…In series of 4 and 26 BD patients by the same group, an Ambu bag with a PEEP valve was connected to the ETT with 10 L/min of 100% oxygen flow upon ventilator disconnection, resulting in stable PaO 2 /FiO 2 (P/F) ratio when compared to prior to AT [17,18]. In a recent comparison of the classic oxygen insufflation method with the CPAP-AT in 60 patients, a gradual decrease of P/F ratio was found throughout conventional AT, but not in the CPAP group [15]. In a Korean study comparing MAT to conventional AT, mean duration of AT was similar, without significant differences in change of PaCO 2 , PaO 2 or pH.…”

“…Reduction of Sweep Gas Flow Madden et al [73] Saucha et al [74] Shah and Lazaridis [71] Lie and Hwang [75] Solek-Pastuszka et al [15] Giani et al [41] Carbogen or CO 2 supplementation Andrews et al [70] Madden et al [76] Beam et al [77] Blood Gas Monitoring Draw ABGs from two sites: radial and post-oxygenator site Ihle et al [80] should be done from two different sites. For patients on VA-ECMO, different gas tensions (i.e., PaCO 2 ) may exist at different arterial sampling sites.…”

“…In Korea, two apnea tests separated by six hours are needed [19]. Regarding timing of AT, it is recommended that AT is performed at the end of the BD assessment to minimize risk of harm [4,7,15,86].…”

Apnea Test Safety in Brain Death: A Single-Center Retrospective Cohort Analysis

“…Low blood pressure, arrhythmias, and/or hypoperfusion, which may lead to interrupting the test and impairment of organ function are mentioned. This condition may impact the quality and survival of the organs to be donated [3]. In this trial, we aimed to assess the safety of ATs in patients undergoing a BD protocol.…”