open access

Vol 47, No 4 (2015)
Review articles
Submitted: 2015-09-20
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Evolution of apnoea test in brain death diagnostics

Joanna Sołek-Pastuszka, Wojciech Saucha, Waldemar Iwańczuk, Romuald Bohatyrewicz
DOI: 10.5603/AIT.2015.0050
·
Anaesthesiol Intensive Ther 2015;47(4):363-367.

open access

Vol 47, No 4 (2015)
Review articles
Submitted: 2015-09-20

Abstract

The concept of brain death (BD) was initially described in 1959 and subsequently became widely accepted in the majority of countries. Nevertheless, the diagnostic guidelines for BD markedly differ, especially regarding the apnoea test (AT), a crucial element of clinical BD confirmation. The current basic guidelines recommend preoxygenation rather than disconnection from the ventilator and insertion of an oxygen insufflation catheter into the endotracheal tube. Although a properly prepared and conducted AT is relatively safe, it has to be aborted in cases of serious disturbances, such as severe cardiac arrhythmia, cardiac arrest, hypotension, hypercarbia, desaturation and tension pneumothorax. These complications may be more frequent in patients with previously existing risk factors, such as poor oxygenation, severe acidosis, hypotension and cardiac rhythm disturbances. Airway injuries can occur if the insufflation catheter is placed too deep or catheter-related obstruction of the intubation tube occurs. It is widely accepted that AT should be performed as the very last BD diagnostic procedure due to its possible lethal consequences. Reports concerning the possible pitfalls of AT and confounding situations have inspired attempts to determine the most effective and safe method of AT. The use of CPAP with oxygen supplementation is becoming highly popular. CPAP can be generated in three manners: directly by the ventilator; through the use of a CPAP valve with a reservoir; and through the use of a highly traditional T-piece system with a reservoir bag connected to distal tubing immersed in water.

Abstract

The concept of brain death (BD) was initially described in 1959 and subsequently became widely accepted in the majority of countries. Nevertheless, the diagnostic guidelines for BD markedly differ, especially regarding the apnoea test (AT), a crucial element of clinical BD confirmation. The current basic guidelines recommend preoxygenation rather than disconnection from the ventilator and insertion of an oxygen insufflation catheter into the endotracheal tube. Although a properly prepared and conducted AT is relatively safe, it has to be aborted in cases of serious disturbances, such as severe cardiac arrhythmia, cardiac arrest, hypotension, hypercarbia, desaturation and tension pneumothorax. These complications may be more frequent in patients with previously existing risk factors, such as poor oxygenation, severe acidosis, hypotension and cardiac rhythm disturbances. Airway injuries can occur if the insufflation catheter is placed too deep or catheter-related obstruction of the intubation tube occurs. It is widely accepted that AT should be performed as the very last BD diagnostic procedure due to its possible lethal consequences. Reports concerning the possible pitfalls of AT and confounding situations have inspired attempts to determine the most effective and safe method of AT. The use of CPAP with oxygen supplementation is becoming highly popular. CPAP can be generated in three manners: directly by the ventilator; through the use of a CPAP valve with a reservoir; and through the use of a highly traditional T-piece system with a reservoir bag connected to distal tubing immersed in water.

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Keywords

brain death, diagnosis, apnoea test

About this article
Title

Evolution of apnoea test in brain death diagnostics

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 47, No 4 (2015)

Pages

363-367

DOI

10.5603/AIT.2015.0050

Bibliographic record

Anaesthesiol Intensive Ther 2015;47(4):363-367.

Keywords

brain death
diagnosis
apnoea test

Authors

Joanna Sołek-Pastuszka
Wojciech Saucha
Waldemar Iwańczuk
Romuald Bohatyrewicz

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