The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Maria Madden, Peter Saunders, Kate Dolly, Rebecca Manship, Dr. Nader Habashi; University of Maryland Medcial Center/Shock Trauma, Baltimore, MD

Introduction: The use of carbogen for apnea testing during the declaration of brain death continues to grow in adult patient populations. However, to date, there are no documented cases in pediatric patients. The brain death declaration process includes a confirmatory presence of apnea. A persistent absence of clinical brain function must be demonstrated on two consecutive examinations separated in time, based on the patient's age or a single clinical exam with confirmatory testing, when appropriate. When confirming brain death on adults, there should be at least six hours between exams and at least twelve hours between exams on children > 12 months and < 18 years of age. In cases of hypoxic-ischemic encephalopathy, a period of twenty-four hours should exist between exams. Case Summary: This is a 13 year old that was diagnosed with an anoxic injury due to a house fire and was being evaluated for brain death. The bedside assessment, performed by an attending physician, found there was enough clinical data to declare brain death. The carbogen method was selected for the apnea test due to high mean airway pressure at 25 cm H2O and the desire to prevent derecruitment with the traditional method. Another advantage the carbogen method provides compared to traditional apnea tests is increased assessment of spontaneous effort. In the initial carbogen test the patient demonstrated spontaneous efforts within three minutes. Spontaneous effort was noted on the ventilator respiratory rate, waveforms, ETCO2 monitor and by assessing chest movement. The patient was then reassessed for apnea using the carbogen method two days later and was positive on the initial exam as well as the follow-up. The apnea test reached its goal at 6 minutes on both tests with no adverse effects. Discussion: The carbogen apnea test in this case study demonstrated the increased assessment tools for identifying spontaneous effort. It also continued to provide less chance of pulmonary or cardiac adverse effects and a predictable end point test compared to the standard apnea test.
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