A new technique for avoiding barotrauma-induced complications in apnea testing for brain death

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
John T DennyArpit N Patel

Abstract

Prompted by our experience with complications occurring with apnea testing (AT), we discuss complications reported in the literature. AT is an integral part of brain death assessment. Many complications of AT have been described, including hypoxemia, arterial hypotension, tension pneumothorax and cardiac arrest. We conclude that a commonly used technique in conducting AT can create auto-positive end expiratory pressure (PEEP) and contributes to many complications. The mechanism of occult auto-PEEP in AT is discussed. Intensive care unit patients may have a compensated and asymptomatic relative hypovolemia that can be decompensated by a small amount of auto-PEEP produced by air trapping during insufflating oxygen (O2) through a 7.0 endotracheal tube (ETT). It could then lead to decreased preload, decreased stroke volume, decreased cardiac output and thus, to hypotension and a compensatory tachycardia. The placement of the standard O2 tubing (6mm outside diameter [OD]) inside the 7.0 ETT (7mm inside diameter [ID]) greatly decreased the ETT lumen (73%). We changed our practice to instead use readily available small pressure tubing to insufflate O2 for AT to avoid excessive reduction in the ETT lumen. The change from standard O2 tu...Continue Reading

References

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Mar 4, 2008·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Joseph D Burns, James A Russell

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Citations

Nov 12, 2015·Intensive Care Medicine·Marco GianiGiuseppe Citerio
Aug 9, 2016·Current Neurology and Neuroscience Reports·Carolina B Maciel, David M Greer
Jun 12, 2020·Neurocritical Care·Katharina M BuslPanayiotis N Varelas

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