Abstract
The establishment of apnea for the diagnosis of brain death by disconnecting the patient from the ventilator may lead to dangerous hypoxemia at the end of the test period. We established apnea for 4 min in 8 patients with suspected brain death, both by disconnecting them from the ventilator after 10 min ventilation with FIO2=1.0 (method “A”), and by leaving them attached to an IMV ventilator circuit with a continuous flow of 100% O2 and PEEP of 4–8 cm H2O without mechanical ventilation (method “B”). PaO2 decreased during the apneic period by 143 ±65 (SD) mmHg using method “A”, and by 48±28 mmHg using method “B” (p<0.002). The changes in PaCO2 and pH were similar following both apneic methods.
We conclude that it is safer to test for apnea by leaving the patients on a continuous flow of 100% oxygen and low PEEP than to disconnect them from the ventilator.
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References
Black PM (1978) Brain death. N Eng J Med 299:338, 393
Brandfonbrener M, Kroll G, Borden C (1969) Posthyperventilation apnea and the criteria of brain damage and death. Am Heart J 78:573
Frost EAM, Arancibia CU, Shulman K (1979) Pulmonary shunt — as a prognostic indicator in head injury. J Neurosurg 50:768
Graybar GB, Smith RA (1980) Apparatus and techniques for intermittent mandatory ventilation. In: Kirby RR, Graybar GB (eds) Intermittent mandatory ventilation. International Anesthesiology Clinics 18:53
Pitts LH, Kaktis J, Caronna J, Jennet S, Hoff JT (1978) Brain death, apneic diffusion oxygenation and organ transplantation. J Trauma 18:180
Schafer JA, Caronna JJ (1978) Duration of apnea needed to confirm brain death. Neurology 28:661
Schumaker PT, Rhodes GR, Newell JC, Shah DM, Scovill WA, Powers SR (1979) Ventilation — perfusion imbalance after head trauma. Am Rev Resp Dis 119:33
Conference of Medical Royal Colleges in the United Kingdom (1976) Diagnosis of brain death. Br Med J 2:1187
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Perel, A., Berger, M. & Cotev, S. The use of continuous flow of oxygen and PEEP during apnea in the diagnosis of brain death. Intensive Care Med 9, 25–27 (1983). https://doi.org/10.1007/BF01693702
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DOI: https://doi.org/10.1007/BF01693702