Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature

The diagnosis of brain death is a complex process. Strong knowledge of neurophysiology and an understanding of brain death etiology must be used to confidently determine brain death. The key findings in brain death are unresponsiveness, and absence of brainstem reflexes in the setting of a devastating neurological injury. These findings are coupled with a series of confirmatory tests, and the diagnosis of brain death is established based on consensus recommendations. The drive to breathe in the setting of an intense ventilatory stimulus (ie, respiratory acidosis) is a critical marker of brainstem function. As a consequence, apnea testing is an important component of brain death assessment. This procedure requires close monitoring of a patient as all ventilator support is temporarily removed and Paco2 levels are allowed to rise. A “positive” test is defined by a total absence of respiratory efforts under these conditions. While apnea testing is not new, it still lacks consensus standardization regarding the actual procedure, monitored parameters, and evidence-based safety measures that may be used to prevent complications. The purpose of this report is to provide an overview of apnea testing and discuss issues related to the administration and safety of the procedure.

Brain death declaration

PDF) Apnea Test Safety in Brain Death: A Single-Center Retrospective Cohort Analysis

Brain Death - EMCrit Project

Apnea testing for the diagnosis of brain death - Lang - 2005 - Acta Neurologica Scandinavica - Wiley Online Library

Determination of Brain Death

Potential Threats and Impediments to the Clinical Practice of Brain Death Determination

Graph showing the rate of pO2 decrease during apnea. The closed boxes

PDF) Apnea Test Safety in Brain Death: A Single-Center Retrospective Cohort Analysis

Figure 2 from Brain death: assessment, controversy, and confounding factors.

Table 1 from Problems associated with the apnea test in the diagnosis of brain death.