Apnea testing during brain death assessment: a review of clinical practice and published literature.

Published

Journal Article (Review)

The diagnosis of brain death is a complex process. Strong knowledge of neurophysiology and an understanding of brain death etiology must be used to confidently determine brain death. The key findings in brain death are unresponsiveness, and absence of brainstem reflexes in the setting of a devastating neurological injury. These findings are coupled with a series of confirmatory tests, and the diagnosis of brain death is established based on consensus recommendations. The drive to breathe in the setting of an intense ventilatory stimulus (ie, respiratory acidosis) is a critical marker of brainstem function. As a consequence, apnea testing is an important component of brain death assessment. This procedure requires close monitoring of a patient as all ventilator support is temporarily removed and Paco2 levels are allowed to rise. A "positive" test is defined by a total absence of respiratory efforts under these conditions. While apnea testing is not new, it still lacks consensus standardization regarding the actual procedure, monitored parameters, and evidence-based safety measures that may be used to prevent complications. The purpose of this report is to provide an overview of apnea testing and discuss issues related to the administration and safety of the procedure.

Full Text

Duke Authors

Cited Authors

  • Scott, JB; Gentile, MA; Bennett, SN; Couture, M; MacIntyre, NR

Published Date

  • March 2013

Published In

Volume / Issue

  • 58 / 3

Start / End Page

  • 532 - 538

PubMed ID

  • 22709413

Pubmed Central ID

  • 22709413

Electronic International Standard Serial Number (EISSN)

  • 1943-3654

Digital Object Identifier (DOI)

  • 10.4187/respcare.01962

Language

  • eng

Conference Location

  • United States