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In Search of a Safe Apnea Test in Brain Death: Is the Procedure Really More Dangerous Than We Think?

In Search of a Safe Apnea Test in Brain Death: Is the Procedure Really More Dangerous Than We Think? Abstract Maintaining a minimum systolic blood pressure of 90 mm Hg ensures adequate perfusion to all vital organs that may potentially be used for donation. That hypotension develops during apnea testing in certain patients who otherwise fulfill the clinical criteria of brain death is well recognized. Causes of hypotension in brain death may be related to cardiac arrhythmias, cardiac stunning, diabetes insipidus, prior use of diuretics and fluid restriction in the management of primary brain injury, or loss of arterial and venous sympathetic tone as a result of destruction of the pontine and medullary vasomotor structures.1 Neurologists do not like to perform apnea testing, and they do it in an inappropriate manner. In a survey of neurologists in Colorado and California, Earnest et al2 found that only one of eight neurologists vigorously performed apnea testing by providing 100% oxygen during testing and by measuring arterial blood gas levels. One References 1. Darby JM, Stein K, Grenvik A, Stuart SA. Approach to management of the heart beating 'brain dead' organ donor . JAMA . 1989;261:2222-2228.Crossref 2. Earnest MP, Beresford HR, McIntyre HB. Testing for apnea in suspected brain death: methods used by 129 clinicians . Neurology . 1986;36:542-544.Crossref 3. Jeret JS, Benjamin JL. Risk of hypotension during apnea testing . Arch Neurol . 1994;51:595-599.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

In Search of a Safe Apnea Test in Brain Death: Is the Procedure Really More Dangerous Than We Think?

Archives of Neurology , Volume 52 (4) – Apr 1, 1995

In Search of a Safe Apnea Test in Brain Death: Is the Procedure Really More Dangerous Than We Think?

Abstract

Abstract Maintaining a minimum systolic blood pressure of 90 mm Hg ensures adequate perfusion to all vital organs that may potentially be used for donation. That hypotension develops during apnea testing in certain patients who otherwise fulfill the clinical criteria of brain death is well recognized. Causes of hypotension in brain death may be related to cardiac arrhythmias, cardiac stunning, diabetes insipidus, prior use of diuretics and fluid restriction in the management of primary brain...
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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1995.00540280018005
Publisher site
See Article on Publisher Site

Abstract

Abstract Maintaining a minimum systolic blood pressure of 90 mm Hg ensures adequate perfusion to all vital organs that may potentially be used for donation. That hypotension develops during apnea testing in certain patients who otherwise fulfill the clinical criteria of brain death is well recognized. Causes of hypotension in brain death may be related to cardiac arrhythmias, cardiac stunning, diabetes insipidus, prior use of diuretics and fluid restriction in the management of primary brain injury, or loss of arterial and venous sympathetic tone as a result of destruction of the pontine and medullary vasomotor structures.1 Neurologists do not like to perform apnea testing, and they do it in an inappropriate manner. In a survey of neurologists in Colorado and California, Earnest et al2 found that only one of eight neurologists vigorously performed apnea testing by providing 100% oxygen during testing and by measuring arterial blood gas levels. One References 1. Darby JM, Stein K, Grenvik A, Stuart SA. Approach to management of the heart beating 'brain dead' organ donor . JAMA . 1989;261:2222-2228.Crossref 2. Earnest MP, Beresford HR, McIntyre HB. Testing for apnea in suspected brain death: methods used by 129 clinicians . Neurology . 1986;36:542-544.Crossref 3. Jeret JS, Benjamin JL. Risk of hypotension during apnea testing . Arch Neurol . 1994;51:595-599.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Apr 1, 1995

References