Apnea Documentation for Determination of Brain Death in Children

PEDIATRICS ◽  
1984 ◽  
Vol 74 (4) ◽  
pp. 505-508
Author(s):  
Thomas W. Rowland ◽  
Joseph H. Donnelly ◽  
Anthony H. Jackson
Keyword(s):  
Brain Death ◽  
Ventilatory Support ◽  
Respiratory Drive ◽  
Test Protocol ◽  
Apnea Test ◽  
Wide Variability ◽  
Adequate Oxygenation

Discontinuing ventilatory support for determination of respiratory drive is a recognized means of assessing clinical brain death. Methodology must include a means for assuring adequate oxygenation during the test as well as providing sufficient duration for appropriate hypercarbia. Nine patients with other findings of clinical brain death were prospectively assessed with a standardized apnea test protocol. None demonstrated spontaneous respirations. Whereas adequate oxygenation was maintained in each case, wide variability was evident in degree of hypercarbia and acidosis.

Brain Death

2017 ◽  
Author(s):  
Anupamaa Seshadri ◽  
Ali Salim
Keyword(s):  
Brain Death ◽  
Apnea Test ◽  
Brainstem Reflex ◽  
Practice Parameters ◽  
Confirmatory Tests ◽  
History Of ◽  
Pediatric Populations ◽  
Definition Of

The concept of “brain death” is one that has been controversial over time, requiring the development of clear guidelines to diagnose and give prognoses for patients after devastating neurologic injury. This review discusses the history of the definition of brain death, as well as the most recent guidelines and practice parameters on the determination of brain death in both the adult and pediatric populations. We provide specific and detailed instructions on the various clinical tests required, including the brain death neurologic examination and the apnea test, and discuss pitfalls in the diagnosis of brain death. This review also considers the most recent literature and guidelines as to the role of confirmatory tests making this diagnosis.  Key Words: apnea test, brain death, brainstem reflex, death examination

scholarly journals Complications associated with the apnea test in the determination of the brain death

2008 ◽  
Vol 121 (13) ◽  
pp. 1169-1172 ◽  
Author(s):  
Xiao-liang WU ◽  
Qiang FANG ◽  
Li LI ◽  
Yun-qing QIU ◽  
Ben-yan LUO
Keyword(s):  
Brain Death ◽  
Apnea Test ◽  
The Brain

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.

482: APNEA TEST FOR DETERMINATION OF BRAIN DEATH IN A CHILD ON VENOARTERIAL ECMO

2018 ◽  
Vol 46 (1) ◽  
pp. 225-225
Author(s):  
Haitham Al Wahab ◽  
Vandana Thapar ◽  
Myron Allukian ◽  
Konstantinos Boukas
Keyword(s):  
Brain Death ◽  
Apnea Test

Critics and Brain Death

2017 ◽  
Author(s):  
Eelco F.M. Wijdicks
Keyword(s):  
Brain Death ◽  
Apnea Test ◽  
Life And Death ◽  
Total Brain ◽  
Women And Children ◽  
Brain Dead ◽  
Hypothalamic Function ◽  
Fair Assessment

Matters of life and death—and the physician’s role—invite criticisms and alternate interpretations. Commentaries against the clinical diagnosis of brain death or the concept of brain death have shifted their focus. These range from criticisms of the Harvard Committee (alleging conflict of interest, as shown by the presence of transplant physicians), to clinical examination (alleging injury with the apnea test), to critiques of the total brain necrosis criteria (alleging intact pituitary and hypothalamic function), to critiques on the difficulty of support (alleging long-term support in pregnant “brain-dead” women and children) and, most recently, to critiques on irreversibility (alleging possible recoveries). Philosophical arguments may reach the bedside, which may become consequential. In this chapter, a fair assessment of these criticisms, particularly those regarding determination of brain death, is provided, followed by a rebuttal. Practitioners should be aware of the existing body of literature analyzed herein.

Neurology of Brain Death

2017 ◽  
Author(s):  
Eelco F.M. Wijdicks
Keyword(s):  
Brain Death ◽  
American Academy ◽  
Task Force ◽  
Respiratory Drive ◽  
Apnea Test ◽  
Clinical Criteria ◽  
Joint Task ◽  
Adults And Children ◽  
Full Discussion ◽  
Definition Of

The diagnosis of brain death is based on a comprehensive neurological evaluation. First, physicians need to eliminate confounders to the clinical examination. Once excluded, a set of neurological tests and a formal apnea test (to document absent respiratory drive after CO2 challenge) often will suffice. Second, ancillary tests may be needed if some parts of the neurological examination cannot be accurately assessed. This chapter provides a full discussion of the clinical criteria in adults and children and is modeled after the guidelines of the American Academy of Neurology and the 2011 definition of pediatric brain death by a joint task force of the Society of Critical Care Medicine, the American Academy of Pediatrics, and the Child Neurology Society.

The apnea test for the determination of brain death

1989 ◽  
Vol 71 (2) ◽  
pp. 191-194 ◽  
Author(s):  
Edward C. Benzel ◽  
Charles D. Gross ◽  
Theresa A. Hadden ◽  
Lee Kesterson ◽  
Michael D. Landreneau
Keyword(s):  
Brain Death ◽  
Average Rate ◽  
Tracheobronchial Tree ◽  
Apnea Test ◽  
Content Type ◽  
Arterial Blood ◽  
Volume Ventilation ◽  
Gas Measurements ◽  
Fine Print

✓ By conventional criteria, an apneic patient's PaCO2 must be greater than 60 mm Hg before apnea can be attributed to brain death. The rate of a PaCO2 increase in the apneic patient traditionally has been thought to be in the range of 3 mm Hg/min. In order to assess the validity of these data and the validity of the “apnea test” for determination of brain death, the results of this test were reviewed in 20 patients. In all patients, arterial blood samples were drawn for blood gas measurements every 2 minutes following the cessation of volume ventilation (with an oxygen cannula at 6 liters O2/min passed into the tracheobronchial tree). The rate of PaCO2 increase was noted to be very erratic. The average rate of rise was 3.7 ± 2.3 mm Hg/min (± standard deviation). This, however, varied from 0.5 to 10.5 mm Hg/min and was not predictable from the variables evaluated. The rate of PaCO2 increase was noted to decline throughout the duration of the test. This ranged from 3.9 ± 1.2 mm Hg/min (for patients with baseline PaCO2 ≤ 30 mm Hg) and 4.5 ± 1.9 mm Hg/min (for patients with baseline PaCO2 ≥ 30 mm Hg) in the first 4 minutes of the test to an average of 0.92 mm Hg/min for patients with test lasted longer than 12 minutes. These unpredictable results might be related to CO2 washout, atelectasis, cardiac ventilations, or other yet-undefined parameters. The nonlinear relationship between rate of PaCO2 increase and time following onset of apnea resulted in the test being prolonged in several patients. In these patients, the PaCO2 approached 60 mm Hg in an asymptotic fashion. These lengthy tests could have been avoided by utilizing a standardized apnea test with a baseline PaCO2 of 40 mm Hg or greater. The observation that a high baseline PaCO2 greatly augments the efficiency and safety of the test allows criteria that have previously been based on conjecture to be documented and applied clinically. A standardized apnea test, utilizing these principles, may satisfy many of the criticisms regarding brain-death testing that have been raised by neurologists, neurosurgeons, and transplant surgeons.

POWER SPECTRAL ANALYSIS OF HEART RATE VARIABILITY DURING APNEA TEST FOR DETERMINATION OF BRAIN DEATH

Shock ◽  
1995 ◽  
Vol 4 (Supplement) ◽  
pp. 44
Author(s):  
KAWAMOTO Masashi ◽  
SERA Akihiko ◽  
YUGE Osafumi ◽  
OHTANI Minako
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Spectral Analysis ◽  
Brain Death ◽  
Power Spectral Analysis ◽  
Apnea Test ◽  
Power Spectral

scholarly journals Use of CPAP as an alternative to the apnea test during the determination of brain death in hypoxemic patients. Report of two cases

2020 ◽  
Vol 32 (2) ◽  
Author(s):  
Glauco Adrieno Westphal ◽  
Veviani Fernandes ◽  
Verônica Westphal ◽  
Jessica Cangussu Fonseca ◽  
Luciano Rodrigues da Silva ◽  
...  
Keyword(s):  
Brain Death ◽  
Apnea Test

Neurology of Brain Death

2013 ◽  
Author(s):  
Eelco F.M. Wijdicks
Keyword(s):  
Brain Death ◽  
Apnea Test ◽  
Clinical Determination

Chapter 2 discusses the neurology and pathology of brain death, clinical and ancillary examination protocols for adults, the apnea test, and the clinical determination of brain death in children. It also discusses errors and alleged recoveries, and legal definitions and obligations.

Sign in / Sign up

Export Citation Format

Share Document