The apnea test for the determination of brain death

Journal of Neurosurgery
E C BenzelM D Landreneau

Abstract

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 less than or equal to 30 mm Hg) and 4.5 +/- 1.9 mm Hg/min (for patients with baseline PaCO2 greater than or equal to 30 mm Hg) in the first 4 minutes of the test to an average of 0.92 mm Hg/min for patients with...Continue Reading

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