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


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: 01-10-2005

Copyright Statement:  Copyright © 2014; The Author(s).


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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  1. Shemie SD, Doig C, Dickens B, Byrne P, Wheelock B, Rocker G, et al. Severe brain injury to neurological determination of death: Canadian forum recommendations. CMAJ 2006;174:S1-13.
  2. Wijdicks EF, Varelas PN, Gronseth GS, Greer DM, American Academy of Neurology. Evidence-based guideline update: Determining brain death in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010;74:1911-8.
  3. Goudreau JL, Wijdicks EF, Emery SF. Complications during apnea testing in the determination of brain death: Predisposing factors. Neurology 2000;55:1045-8.
  4. Lévesque S, Lessard MR, Nicole PC, Langevin S, LeBlanc F, Lauzier F, et al. Efficacy of a T-piece system and a continuous positive airway pressure system for apnea testing in the diagnosis of brain death. Crit Care Med 2006;34:2213-6.
  5. Hocker S, Whalen F, Wijdicks EF. Apnea testing for brain death in severe acute respiratory distress syndrome: A possible solution. Neurocrit Care 2014;20:298-300.
  6. Bar-Joseph G, Bar-Lavie Y, Zonis Z. Tension pneumothorax during apnea testing for the determination of brain death. Anesthesiology 1998;89:1250-1.
  7. Grasso S, Mascia L, Del Turco M, Malacarne P, Giunta F, Brochard L, et al. Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 2002;96:795-802.
  8. Jeret JS, Benjamin JL. Risk of hypotension during apnea testing. Arch Neurol 1994;51:595-9.
  9. Bein T, Kuhr LP, Bele S, Ploner F, Keyl C, Taeger K. Lung recruitment maneuver in patients with cerebral injury: Effects on intracranial pressure and cerebral metabolism. Intensive Care Med 2002;28:554-8.
  10. Frumin MJ, Epstein RM, Cohen G. Apneic oxygenation in man. Anesthesiology 1959;20:789-98.
  11. Mascia L, Pasero D, Slutsky AS, Arguis MJ, Berardino M, Grasso S, et al. Effect of a lung protective strategy for organ donors on eligibility and availability of lungs for transplantation: A randomized controlled trial. JAMA 2010;304:2620-7.
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