scholarly journals Apnea Threshold in Pediatric Brain Death: A Case with Variable Results Across Serial Examinations

2018 ◽  
Vol 08 (02) ◽  
pp. 108-112
Author(s):  
Tina Sosa ◽  
Zachary Berrens ◽  
Susan Conway ◽  
Erika Stalets
Keyword(s):  
Brain Death ◽  
Pediatric Patients ◽  
The Family ◽  
Apnea Threshold ◽  
Unexpected Findings ◽  
Pediatric Brain ◽  
Current Guidelines ◽  
Apnea Testing ◽  
Observation Period

AbstractConsensus guidelines currently exist for the evaluation of pediatric patients with suspected brain death. The guidelines include the requirement for two consistent examinations separated by an observation period and a threshold of 60 mm Hg for PaCO2 during apnea testing. We present a patient who met all prerequisites to perform brain death examination but had variability in examinations during apnea testing. We discuss our strategy in managing these unexpected findings, including the importance of open and ongoing communication with the family, and the implications for current guidelines for the determination of brain death in pediatric patients.

Return of Spontaneous Respiration in an Infant Who Fulfilled Current Criteria to Determine Brain Death

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 518-520
Author(s):  
Ken Okamoto ◽  
Tsuyoshi Sugimoto
Keyword(s):  
Young Children ◽  
Brain Death ◽  
American Academy ◽  
Task Force ◽  
Spontaneous Respiration ◽  
American Academy Of Pediatrics ◽  
New Guidelines ◽  
Current Guidelines ◽  
Child's Brain

It is generally assumed that the child's brain is more resistant to insults leading to death. Current guidelines for brain death, therefore, avoid application of these standards to young children.1 The determination of brain death in children, however, has become increasingly important, and different sets of new guidelines for children have been recently published.1-4 Especially, the recommendations of a special task force, consisting of representatives from neurologic organizations and the American Academy of Pediatrics, were published in five major journals.4 Those primary distinctions were three separate longer observation periods depending on the child's age and the necessity for two corroborating electroencephalograms (EEGs) or one EEG with a corroborating cerebral radionucleotide angiogram.

Apnea testing for the determination of brain death: a modified protocol

1992 ◽  
Vol 76 (6) ◽  
pp. 1029-1031 ◽  
Author(s):  
Edward C. Benzel ◽  
Jay P. Mashburn ◽  
Steven Conrad ◽  
Denise Modling
Keyword(s):  
Brain Death ◽  
Apnea Test ◽  
Content Type ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Safe Approach ◽  
Apnea Testing ◽  
Fine Print

✓ The absence of spontaneous respirations at a PaCO2 of 60 mm Hg or above has traditionally been accepted as the respiratory criteria for the determination of brain death. The testing of patients for the presence or absence of apnea has been complicated because the rate of PaCO2 elevation may vary substantially from patient to patient, and a nonlinear relationship exists between the rate of PaCO2 increase and the duration of apnea. In an attempt to refine the apnea test and to further elucidate the physiology of hypercapnia in humans, 11 patients who met all but the respiratory criteria for brain death were evaluated using a modification of a previously utilized apnea testing protocol. All patients were brought to a PaCO2 of 40 mm Hg or above prior to the apnea test. Baseline PaCO2 ranged from 40 to 45 mm Hg in six patients (Group I) and from 46 to 51 mm Hg in five patients (Group II). The mean rate of PaCO2 increase was 5.1 ± 1.4 mm Hg/min in Group I and 6.7 ± 3.1 mm Hg/min in Group II. No problems with cardiovascular instability or hypoxia were encountered during testing in this series. This refinement of the apnea test allows for a streamlined and safe approach to brain death detection.

Challenges to the Determination of Death by Neurological Criteria

2019 ◽  
Vol 19 (4) ◽  
pp. 583-599
Author(s):  
Tadeusz Pacholczyk ◽  
Stephen Hannan ◽  
Keyword(s):  
Brain Death ◽  
Determination Of Death ◽  
Ethical Concerns ◽  
Diagnostic Practices ◽  
Testing Potential ◽  
Brain Dead ◽  
Testing Protocols ◽  
The Brain ◽  
Apnea Testing

Ethical concerns regarding the conceptual framework for the determination of death by neurological criteria, including several clinical and diagnostic practices, are addressed. The significance of a diagnosis of brain death, diagnostic criteria, and certain technical aspects of the brain-death exam are presented. Standard and ancillary tests that typically help achieve prudential certitude that an individual has died are indicated. Ethical concerns surrounding interinstitutional variability of testing protocols are evaluated and considered, as are potential apnea-testing confounders such as hypotension, hypoxemia, hypercarbia, and penumbra effects during ancillary testing. Potential adjustments to apnea-testing protocols involving capnography, thoracic impedance monitors, or spirometers to assess respiratory efforts are discussed. Situations in which individuals determined to be brain dead “wake up,” or fail to manifest the imminent cessation of somatic functioning typically seen when supported only by a ventilator, are also briefly reviewed.

Apnea Threshold and Pediatric Brain Death

2000 ◽  
Vol 28 (4) ◽  
pp. 1257 ◽  
Author(s):  
Richard J. Brilli ◽  
David Bigos
Keyword(s):  
Brain Death ◽  
Apnea Threshold ◽  
Pediatric Brain

Brain Death Determination in the Newborn

PEDIATRICS ◽  
1987 ◽  
Vol 80 (2) ◽  
pp. 293-297
Author(s):  
JOSEPH J. VOLPE
Keyword(s):  
Brain Death ◽  
Task Force ◽  
Young Infant ◽  
Term Infants ◽  
Brain Functions ◽  
Brain Death Determination ◽  
Death Determination ◽  
Observation Period

This commentary is addressed to the determination of brain death in the newborn and young infant and in particular is meant to elaborate the rationale for two aspects of the guidelines established by the Task Force on Brain Death in Children.1 The two aspects are (1) the application of the guidelines to term infants seven days of age or older and (2) the recommendation of an observation period of at least 48 hours in infants between seven days and 2 months of age. The two essential requirements for the diagnosis of brain death are, first, the establishment of cessation of all brain functions, ie, cerebral and brainstem functions, and second, the demonstration that cessation of these functions is irreversible.

Complications during apnea testing in the determination of brain death: Predisposing factors

Neurology ◽  
2000 ◽  
Vol 55 (7) ◽  
pp. 1045-1048 ◽  
Author(s):  
J. L. Goudreau ◽  
E. F. M. Wijdicks ◽  
S. F. Emery
Keyword(s):  
Brain Death ◽  
Predisposing Factors ◽  
Apnea Testing
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