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VOLUME 18 , ISSUE 5 ( May, 2014 ) > List of Articles

CASE REPORT

Apnea testing with continuous positive airway pressure for the diagnosis of brain death in a patient with poor baseline oxygenation status

Gentle Sunder Shrestha, Roshana Amatya, Gopal Sedain, Pramesh Shrestha, Subhash Acharya, Sandip Bhandari, Diptesh Aryal, Bikram Gajurel, Moda Marhatta

Keywords : Apnea test, brain death, poor baseline oxygenation

Citation Information : Shrestha GS, Amatya R, Sedain G, Shrestha P, Acharya S, Bhandari S, Aryal D, Gajurel B, Marhatta M. Apnea testing with continuous positive airway pressure for the diagnosis of brain death in a patient with poor baseline oxygenation status. Indian J Crit Care Med 2014; 18 (5):331-333.

DOI: 10.4103/0972-5229.132510

License: CC BY-ND 3.0

Published Online: 00-05-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Apnea testing is a key component in the clinical diagnosis of brain death. Patients with poor baseline oxygenation may not tolerate the standard 8-10 min apnea testing with oxygen insufflation through tracheal tube. No studies have assessed the safety and feasibility of other methods of oxygenation during apnea testing in these types of patients. Here, we safely performed apnea testing in a patient with baseline PaO 2 of 99.1 mm Hg at 100% oxygen. We used continuous positive airway pressure (CPAP) of 10 cm of H 2 O and 100% oxygen at the flow rate of 12 L/min using the circle system of anesthesia machine. After 10 min of apnea testing, PaO 2 decreased to 75.7 mm Hg. There was a significant rise in PaCO 2 and fall in pH, but without hemodynamic instability, arrhythmias, or desaturation. Thus, the apnea test was declared positive. CPAP can be a valuable, feasible and safe means of oxygenation during apnea testing in patients with poor baseline oxygenation, thus avoiding the need for ancillary tests.


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