Ventilator-Delivered Continuous Positive Airway Pressure for Apnea Test in the Diagnosis of Brain Death in Patient With Extremely Poor Baseline Lung Function—Case Report

Sołek-Pastuszka, Joanna; Sawicki, Marcin; Iwańczuk, Waldemar; Bohatyrewicz, Romuald

doi:10.1016/j.transproceed.2016.02.089

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…Further, there were no significant differences in mean arterial blood pressure, pulse rate, central venous pressure, mean pulmonary arterial pressure, and dosage of norepinephrine between the 2 groups (Table 2). Unlike previous studies, [6,18,19] these unexpected results were thought to result from shorter durations apnea tests. A longer duration for the apnea test was expected to result in greater collapse of the brain-dead patient's lungs; thus, the gap in PaO 2 might be larger.…”

Section: Discussioncontrasting

confidence: 85%

“…We had expected that the reduction in PaO 2 or frequency of severe hypoxemia would be smaller in the MAT group than in the CAT group, as in previous studies. [6,18,19] However, there were no significant differences in PaO 2 or frequency of severe hypoxemia. Further, there were no significant differences in mean arterial blood pressure, pulse rate, central venous pressure, mean pulmonary arterial pressure, and dosage of norepinephrine between the 2 groups (Table 2).…”

Section: Discussionmentioning

confidence: 88%

“…Other previous studies also conducted apnea tests for 10 minutes because such length was a standard recommendation. [6,19] However, as mentioned above, we checked ABGAs after 2 or 3 minutes, and then each minute from the start of the apnea test. If the results of ABGA met the diagnostic criteria for brain death, even after only 2 minutes from the start of the test, we discontinued the apnea test and re-started mechanical ventilation promptly.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Proposed safe apnea test using positive end-expiratory pressure valve and short-term blood gas analysis

Park¹,

Lee²,

Hong

2019

Medicine

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The apnea test is an essential examination for the determination of brain death; however, hypotension, hypoxemia, and other complications during the apnea test can affect the stability of brain-dead patients, as well as organ function for recipients. Therefore, it is necessary to establish standard guidelines for apnea testing. The modified apnea test (MAT) comprises delivery of 100% oxygen through the endotracheal tube connected to manual resuscitator (Ambu bag) with the positive end-expiratory pressure (PEEP) valve after disconnection of the mechanical ventilator for maintenance of PEEP. Forty-nine instances of the conventional apnea test (CAT) were performed in 25 brain-dead patients; 77 instances of the MAT were performed in 39 brain-dead patients. The mean duration of the apnea test was 3.5 ± 1.4 minutes in the CAT group and 3.0 ± 1.2 minutes in the MAT group. There were no significant changes in PaCO 2 , PaO 2 , or pH between the CAT and MAT groups ( P = .341, .593, and .503, respectively). In overweight patients (body mass index ≥ 23 kg/m 2 ), MAT prevented dramatic reductions in PaO 2 and SaO 2 ( P < .05 for both). In the patients who had hypoxic brain injury due to hanging, differences in PaO 2 and SaO 2 in the MAT group were significantly smaller than in the CAT group ( P < .05). Although MAT, which was invented to maintain PEEP, was not efficient for all brain-dead patients, it could be helpful in selected patient groups, such as overweight patients or those who had hypoxic injury due to hanging. And clinicians should consider short-term apnea test to avoid unnecessarily prolonged hypoxemia.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Proposed safe apnea test using positive end-expiratory pressure valve and short-term blood gas analysis

Park¹,

Lee²,

Hong

2019

Medicine

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“…Therefore, various methods have been described to perform the apnea test in a more protective fashion in this patient group(6, 10-12). One of the methods described in retrospective studies and case series/reports is the apnea test under continuous positive airway pressure (CPAP) and sometimes without disconnection from the ventilator (13)(14)(15)(16). The aim of this study was to prospectively investigate whether a modi ed version of such an apnea test on the ventilator (i.e.…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of a modified apnea-test without disconnection from the ventilator in brain death candidates

Lambeck,

Bardutzky,

Strecker

et al. 2023

Preprint

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Background: The apnea test (AT) is the central clinical component in the diagnosis of brain death (BD) and normally entails disconnecting the patient from the ventilator followed by tracheal oxygen sufflation to ensure adequate oxygenation. Most international guidelines state that a lack of spontaneous breathing must be demonstrated when PaCO2 ≥ 60mmHg to rate the test as positive. However, the loss of positive end-expiratory pressure (PEEP) that is associated with disconnection from the ventilator may cause rapid desaturation, frequently leading to cardiopulmonary instability (especially in ARDS-patients) and generally putting patients at risk. This prospective study therefore aimed to investigate whether a modified version of the AT (mAT) in which the patient remained connected to the ventilator, is potentially less harmful yet remains a valid test. Methods: mAT was performed in all 140 BD candidates registered between January 2019 and December 2022: After 10 min of pre-oxygenation, (i) PEEP was increased by 2mbar, (ii) ventilation mode was switched to CPAP and (iii) apnea back-up mode was turned off (flow trigger 10l/min). mAT was considered positive when spontaneous breathing occurred upon increasing PaCO2 to ≥ 60 mmHg (baseline 35–45 mmHg). Clinical complications during/after mAT were documented. Results mAT was possible in 139/140 patients and had a median duration of 15 min (IQR 13–19). Severe complications did not occur. In n = 51 patients, the post-mAT PaO2 was lower than that during pre-mAT, while it was equal or higher in n = 88 cases. In ARDS-patients, apneic oxygenation during mAT improved PaO2. In n = 123 cases, there was a transient post-mAT drop in blood pressure, in n = 12 to a MAP < 60 mmHg. Conclusions The mAT is a safe and gentle means for identifying patients in whom the central respiratory drive has not failed.

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Prevention of Hypoxemia During Apnea Testing: A Comparison of Oxygen Insufflation And Continuous Positive Airway Pressure

et al. 2017

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Ventilator-Delivered Continuous Positive Airway Pressure for Apnea Test in the Diagnosis of Brain Death in Patient With Extremely Poor Baseline Lung Function—Case Report

Cited by 5 publications

References 7 publications

Proposed safe apnea test using positive end-expiratory pressure valve and short-term blood gas analysis

Proposed safe apnea test using positive end-expiratory pressure valve and short-term blood gas analysis

Prospective evaluation of a modified apnea-test without disconnection from the ventilator in brain death candidates

Prevention of Hypoxemia During Apnea Testing: A Comparison of Oxygen Insufflation And Continuous Positive Airway Pressure

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