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Apnea testing with continuous positive airway pressure for the diagnosis of brain
death in a patient with poor baseline oxygenation status
#MMPMID24914266
Shrestha GS
; Shrestha PS
; Acharya SP
; Sedain G
; Bhandari S
; Aryal D
; Gajurel B
; Marhatta MN
; Amatya R
Indian J Crit Care Med
2014[May]; 18
(5
): 331-3
PMID24914266
show ga
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 PaO2 of 99.1 mm Hg at 100% oxygen. We used continuous
positive airway pressure (CPAP) of 10 cm of H2O and 100% oxygen at the flow rate
of 12 L/min using the circle system of anesthesia machine. After 10 min of apnea
testing, PaO2 decreased to 75.7 mm Hg. There was a significant rise in PaCO2 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.