The usefulness of end-tidal carbon dioxide monitoring during apnea test in brain-dead patients

Abstract

BackgroundThe apnea test (AT) is essential to confirming the diagnosis of brain death, but critical complications can occur if the AT is maintained over a long period. To minimize the AT period, we used end-tidal carbon dioxide (ETCO2) monitoring because ETCO2 is closely correlated with partial pressure of arterial carbon dioxide (PaCO2). The aim of the present study is to evaluate the usefulness of ETCO2 monitoring during apnea testing.MethodsWe reviewed 61 patients who were pronounced brain dead at our hospital from July 2009 to December 2012. The subjects were divided into two groups: the N-group, in which capnography was not used, and the C-group, in which capnography was used to monitor ETCO2. In the C-group, whenever arterial blood was sampled, the PaCO2 - ETCO2 gradients were calculated and the ventilator setting adjusted to maintain normocapnia prior to apnea testing.ResultsTwenty-eight subjects in the N-group and twenty-nine subjects in the C-group were included. The gender ratio, age, and cause of brain death were not different between the two groups. Prior to the AT, the normocapnia ratio was higher in the C-group than in the N-group. During the AT, the total test period was shorter in the C-group. Moreover, systolic blood pressure increased in the C-group and decreased in the N-group during apnea testing.ConclusionsETCO2 monitoring during AT allows the PaCO2 level to be predicted, which reduces the duration of the test and stabilizes systolic blood pressure. Thus, with ETCO2 monitoring, the AT can be fast and safe.

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

“…Similar safety and test duration results with capnometry were reported in a Korean study of 61 BD patients comparing two groups, with and without EtCO 2 . The total duration of AT was shorter in the capnometry group, and the systolic blood pressure during apnea increased in the capnometry group and decreased in the controls [56].…”

Analisi del corretto utilizzo del monitoraggio EtCO2 nel percorso emergenza-urgenza ed in terapia intensiva

“…During the observation period for the declaration of brain death, the monitoring of the End-Tidal CO 2 (EtCO 2 ) may reduce the time frames and make the apnea test phase safer, with positive effects on the hemodynamic stability. 16 In daily ICU activities, recourse to capnometry monitoring during invasive and noninvasive ventilation reduces the number of hemogasanalyses effected, and acts positively on both the blood supplies as well as on the cost effectiveness of the ward. 4,17,18,19…”

“…2,14,15 Durante il periodo di osservazione per la dichiarazione di morte encefalica, il monitoraggio della End-Tidal CO 2 (ETCO 2 ) può ridurre i tempi e rendere più sicura la fase del test di apnea, con effetti positivi anche sulla stabilità emodinamica. 16 Nella attività quotidiana in ambiente intensivo il ricorso al monitoraggio capnometrico, durante ventilazione invasiva o non invasiva, riduce il numero di emogasnalisi effettuate, agendo positivamente sia sul patrimonio ematico che sulla spesa economica del reparto.…”

Analisi del corretto utilizzo del monitoraggio EtCO2 nel percorso emergenza-urgenza ed in terapia intensiva

“…During the observation period for the declaration of brain death, the monitoring of the End-Tidal CO 2 (EtCO 2 ) may reduce the time frames and make the apnea test phase safer, with positive effects on the hemodynamic stability. 16 In daily ICU activities, recourse to capnometry monitoring during invasive and noninvasive ventilation reduces the number of hemogasanalyses effected, and acts positively on both the blood supplies as well as on the cost effectiveness of the ward. 4,17,18,19…”

“…2,14,15 Durante il periodo di osservazione per la dichiarazione di morte encefalica, il monitoraggio della End-Tidal CO 2 (ETCO 2 ) può ridurre i tempi e rendere più sicura la fase del test di apnea, con effetti positivi anche sulla stabilità emodinamica. 16 Nella attività quotidiana in ambiente intensivo il ricorso al monitoraggio capnometrico, durante ventilazione invasiva o non invasiva, riduce il numero di emogasnalisi effettuate, agendo positivamente sia sul patrimonio ematico che sulla spesa economica del reparto.…”