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Neurocritical Care
Published in: Neurocritical Care 2/2019

Open Access 01-04-2019 | Original Article

Comparison of Two Apnea Test Methods, Oxygen Insufflation and Continuous Positive Airway Pressure During Diagnosis of Brain Death: Final Report

Authors: Joanna Solek-Pastuszka, Jowita Biernawska, Waldemar Iwańczuk, Klaudyna Kojder, Kornel Chelstowski, Romuald Bohatyrewicz, Marcin Sawicki

Published in: Neurocritical Care | Issue 2/2019

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Abstract

Introduction

Deterioration of the pulmonary function after the apnea test (AT) conducted with the classic oxygen insufflation AT (I-AT) is often observed during the brain death (BD) diagnosis procedure. In the present study, two AT methods were compared before a method is recommended for the currently revised Polish BD criteria.

Methods

Classic I-AT and continuous positive airway pressure AT (CPAP-AT) were performed in 60 intensive care unit patients. I-AT was performed at the end of two series of clinical tests, and approximately 1–1.5 h later, after BD was confirmed, a different method, CPAP-AT with 100% FiO2 and CPAP value of 10 cm H2O provided by a ventilator in CPAP mode was performed. The patients in I-AT and CPAP-AT groups were further divided into two subgroups: non-hypoxemic (NH) with good lung function before AT (PaO2/FiO2 index ≥ 200 mmHg) and hypoxemic (H) with poor lung function (PaO2/FiO2 index < 200 mmHg). PaO2 and PaCO2 were recorded prior to I-AT and CPAP-AT at time-point one (T1), 5 min after each test at time-point two (T2), and after 10 min prior to the end of tests at time-point three (T3). The I-AT NH subgroup consisted of 50 patients, and CPAP-AT NH subgroup 43 patients. The I-AT H subgroup consisted of 10 patients, and the CPAP-AT H subgroup 17 patients.

Results

In the I-AT NH subgroup, a gradual decrease in PaO2/FiO2 was observed throughout the AT but not in the CPAP-AT NH subgroup. The PaO2/FiO2 ratio during the AT in the CPAP-AT H group was stable with a slight tendency to increase but not in the I-AT H group. During the first 5 min of the AT, the mean increase in CO2 was approximately 5 mmHg/min. Most patients in all groups met the AT criteria after 5 min of the test.

Conclusions

The results from the study show that I-AT may compromise pulmonary function in some cases and is one of the reasons for the recommendation of a safer option, CPAP-AT, in the currently revised Polish BD criteria. During AT, the mean CO2 increase rate was 5 mmHg/min, which, in most patients, would allow the test to be completed after just 5 min.
Literature
1.
Citerio G, Crippa IA, Bronco A, Vargiolu A, Smith M. Variability in brain death determination in Europe: looking for a solution. Neurocrit Care. 2014;21(3):376–82.CrossRefPubMed
2.
Wijdicks EF, Varelas PN, Gronseth GS, Greer DM. American Academy of, N. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74(23):1911–8.CrossRefPubMed
3.
Pabisiak K. Brain death criteria formulated for transplantation purposes: fact or myth? Anaesthesiol Intensive Ther. 2016;48(2):142–5.CrossRefPubMed
4.
5.
Saucha W, Solek-Pastuszka J, Bohatyrewicz R, Knapik P. Apnea test in the determination of brain death in patients treated with extracorporeal membrane oxygenation (ECMO). Anaesthesiol Intensive Ther. 2015;47(4):368–71.CrossRefPubMed
6.
Bohatyrewicz R, Nestorowicz A, Kusza K. Commentary on diagnosis procedures of brain death. Anestezjol Intens Ter. 2008;40(2):114–6.PubMed
7.
Ahlawat A, Carandang R, Heard SO, Muehlschlegel S. The modified apnea test during brain death determination: an alternative in patients with hypoxia. J Intensive Care Med. 2016;31(1):66–9.CrossRefPubMed
8.
Saposnik G, Rizzo G, Vega A, Sabbatiello R, Deluca JL. Problems associated with the apnea test in the diagnosis of brain death. Neurol India. 2004;52(3):342–5.PubMed
9.
Goudreau JL, Wijdicks EF, Emery SF. Complications during apnea testing in the determination of brain death: predisposing factors. Neurology. 2000;55(7):1045–8.CrossRefPubMed
10.
Hocker S, Whalen F, Wijdicks EF. Apnea testing for brain death in severe acute respiratory distress syndrome: a possible solution. Neurocrit Care. 2014;20(2):298–300.CrossRefPubMed
11.
Shrestha GS, Shrestha PS, Acharya SP, et al. 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):331–3.CrossRefPubMedPubMedCentral
12.
Datar S, Fugate J, Rabinstein A, Couillard P, Wijdicks EF. Completing the apnea test: decline in complications. Neurocrit Care. 2014;21(3):392–6.CrossRefPubMed
13.
Giani M, Scaravilli V, Colombo SM, et al. Apnea test during brain death assessment in mechanically ventilated and ECMO patients. Intensive Care Med. 2016;42(1):72–81.CrossRefPubMed
14.
van der Jagt M, Lin MS, Briegel J. Optimizing apnea testing to determine brain death. Intensive Care Med. 2016;42(1):117–8.CrossRefPubMed
15.
Solek-Pastuszka J, Sawicki M, Iwanczuk W, et al. Apnea testing using the oxygen insufflation method for diagnosis of brain death may compromise pulmonary function. J Crit Care. 2017;44:175–8.CrossRefPubMed
16.
Solek-Pastuszka J, Saucha W, Iwanczuk W, Bohatyrewicz R. Evolution of apnoea test in brain death diagnostics. Anaesthesiol Intensive Ther. 2015;47(4):363–7.CrossRefPubMed
17.
Bein T, Kuhr LP, Bele S, et al. Lung recruitment maneuver in patients with cerebral injury: effects on intracranial pressure and cerebral metabolism. Intensive Care Med. 2002;28(5):554–8.CrossRefPubMed
18.
Yee AH, Mandrekar J, Rabinstein AA, Wijdicks EF. Predictors of apnea test failure during brain death determination. Neurocrit Care. 2010;12(3):352–5.CrossRefPubMed
19.
Denny JT, Denny JE. Novel configuration of laryngeal mask airway. Int J Health Sci (Qassim). 2014;8(4):420–2.
20.
Henry NR, Marshall SG. Apnea testing: the effects of insufflation catheter size and flow on pressure and volume in a test lung. Respir Care. 2014;59(3):406–10.CrossRefPubMed
21.
Lévesque S, Lessard MR, Nicole PC, 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(8):2213–6.CrossRefPubMed
22.
Kramer AH, Couillard P, Bader R, et al. Prevention of hypoxemia during apnea testing: a comparison of oxygen insufflation and continuous positive airway pressure. Neurocrit Care. 2017;27(1):60–7.CrossRefPubMed
Metadata
Title
Comparison of Two Apnea Test Methods, Oxygen Insufflation and Continuous Positive Airway Pressure During Diagnosis of Brain Death: Final Report
Authors
Joanna Solek-Pastuszka
Jowita Biernawska
Waldemar Iwańczuk
Klaudyna Kojder
Kornel Chelstowski
Romuald Bohatyrewicz
Marcin Sawicki
Publication date
01-04-2019
Publisher
Springer US
Published in
Neurocritical Care / Issue 2/2019
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-018-0608-7

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