Skip to main content

Advertisement

Springer Nature Link
Log in

Apnea testing in suspected brain dead children — physiological and mathematical modelling

  • Neonatal and Pediatric Intensive Care
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To study the validity and safety of the traditional apnea test in children, and to evaluate a mathematical equation estimating the hemodynamic response to the apnea test.

Design

A prospective clinical study.

Setting

Pediatric ICU

Patients and participants

38 pediatric patients suffering severe brain injury aged 2 months to 17 years, undergoing apnea testing for brain death.

Measurements and results

Apnea tests were performed 61 times (once in 19 patients, twice in 15, and 3 times in 4 patients). Mean PaCO2 was 41.1±10.6 mmHg before apnea and increased to 68.0±17.6 at 5 min. PaCO2 increased to 81.8±20.1 and 86.0±25.6 at 10 and 15 min, respectively. There was a mean PaCO2 increase by 5.38±1.4 mmHg/min in the first 5 min, and 2.75±0.5 mmHg/min during the next 5 min. We found a statistically significant (p<0.05) linear relationship between the natural logarithm of PaCO2, time, and the logarithm of the initial level of PaCO2. An inverse linear relationship (p<0.05) was found between systemic mean arterial pressure (MAP) and initial level of PaCO2 presented as mathematical correlations and nomograms.

Conclusions

By using our model for predicting MAP and PCO2 prior to apnea testing, hemodynamic embarrassment can be anticipated and prevented, thus allowing a safer procedure in the detection of brain death. Despite the fact that continuous cardiorespiratory monitoring is important, hemodynamic disturbances can be estimated before the apnea test, thus allowing a safer approach to brain death detection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pallis C (1983) ABC of brain stem death. The position in the USA and elsewhere. BMJ 286:209–210

    PubMed  Google Scholar 

  2. Schaffer JA, Coronna JJ (1978) Duration of apnea needed to confirm brain death. Neurology 28:661–666

    PubMed  Google Scholar 

  3. Earnest MP, Beresford R, McIntyre GH (1986) Testing for apnea in suspected brain death. Methods used by 129 clinicians. Neurology 36:42–44

    Google Scholar 

  4. Ropper AH, Kennedy SK, Russell L (1981) Apnea, testing in the diagnosis of brain death: clinical and physiological observations. J Neurosurg 55:942–946

    PubMed  Google Scholar 

  5. Pitts LH, Kakhs J, Caronna J, Jennet S, Hoff JT (1978) Brain death, apneic diffusion, oxygenation and organ transplantation. J Trauma 18:180–183

    PubMed  Google Scholar 

  6. Winer BD (1971) Factorial experiments in which some of the interactions are confounded: examples with repeated measures. In: Winer BD (ed) Statistical principles in experimental design. McGraw Hill, New York, pp 635–639

    Google Scholar 

  7. Belsh JM, Blatt R, Schiffman LP (1986) Apnea testing in brain death. Arch Intern Med 146:2385–2388.

    PubMed  Google Scholar 

  8. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research defining Death (1981) Washington, DC, Government Printing Office, pp 160

  9. Rowland TW, Donnelly JH, Jackson AH (1984) Apnea documentation for determination of brain death in children. Pediatrics 74:505–508

    PubMed  Google Scholar 

  10. Outwater KM, Rockoff MA (1984) Apnea testing to confirm brain death in children. Crit Care Med 12:357–358

    PubMed  Google Scholar 

  11. Perel A, Berger M, Cotev S (1983) The use of continuous flow of oxygen and PEEP during apena in the diagnosis of brain death. Intensive Care Med 9:25–27

    PubMed  Google Scholar 

  12. Marks SY, Zisfein Y (1990) Apneic oxygenation in apnea tests for brain death. A controlled trial. Arch Neurol 47:1066

    PubMed  Google Scholar 

  13. Report of the Ad Hoc committee of the Harvard Medical School (1968) To examine the definition of brain death: A definition of irreversible coma. JAMA 201:337–340

    Google Scholar 

  14. Eger EI, Severinghaus JW (1961) The rate of rise of PaCO2 in the apneic anesthetized patient. Anesthesiology 22(3):419–425

    PubMed  Google Scholar 

  15. Hanks EC, Ngai SH, FWK BR (1961) The respiratory threshold for carbon dioxide in anesthetized man. Anesthesiology 22:393–397

    PubMed  Google Scholar 

  16. Kissoon N, Frewen TC, Bloch M, Gayle M, Stiller C (1989) Pediatric organ maintenance: pathophysiologic derangements and nursing requirements. Pediatrics 84:688–693

    PubMed  Google Scholar 

  17. Bircher N, Safar P, Eshel G et al (1982) Cerebral and hemodynamic variables during cough induced CPR in dogs. Crit Care Med 10:104

    PubMed  Google Scholar 

  18. Novitzky D, Cooper DCK, Morell D et al (1988) Change from aerobic to anaerobic metabolism after brain death, and reversal following triodothyronine therapy. Transplantation 45:32–36

    PubMed  Google Scholar 

  19. Grose A, Novitzky D, Cooper DKC (1988) Myocardial and pulmonary histopathologic changes. Transplant Proc XX (sn(55) [Suppl7]:29–32

    Google Scholar 

  20. Riviello JJ, Sapin JI, Brown LW, Truex RC, Grover WD (1988) Hypoxemia and hemodynamic changes during the hypercarbia stimulation test. Pediatr Neurol 4:213–218

    PubMed  Google Scholar 

  21. Benzel EC, Gross CD, Hadden TA, Kesterson L, Landreneau MD (1989) The apnea test for the determination of brain death. J Neurosurg 71:191–194

    PubMed  Google Scholar 

  22. Frum J, Epstein RM, Cohen G (1959) Apneic oxygenation in man. Anesthesiology 20:789–798

    PubMed  Google Scholar 

  23. Wetzel RC, Setzer N, Stiff JL, Rogers MC (1985) Hemodynamic responses in brain dead organ donor patients. Anesth Analg 64:125

    PubMed  Google Scholar 

  24. Bloomfield E (1989) Extracerebral complications of head injury. Critical Care Clin 5:881–892

    Google Scholar 

  25. Novitzky O, Cooper PKC, Reichart B (1987) Hemodynamic and metabolic responses to therapy in brain dead potential organ donors. Transplantation 43:852–853

    PubMed  Google Scholar 

  26. Miller JR, Nugent SK, Rogers MC (1979) Neurogenic pulmonary edema in childhood. Pediatrics 79:94–706

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit, The Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel

    G. Paret

  2. School of Medicine, The Tel Aviv University Sackler, Tel Aviv, Israel

    Z. Barzilay

Authors
  1. G. Paret
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Z. Barzilay
    View author publications

    You can also search for this author inPubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Paret, G., Barzilay, Z. Apnea testing in suspected brain dead children — physiological and mathematical modelling. Intensive Care Med 21, 247–252 (1995). https://doi.org/10.1007/BF01701482

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01701482

Key words