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A Model to Simulate Clinically Relevant Hypoxia in Humans
Published on: December 22, 2016
Increased apnea threshold in a pediatric patient with suspected brain death
1Department of Critical Care, Children's National Medical Center, Washington, DC, USA.
Objective:
To evaluate the current standards for apnea testing in the evaluation of brain death in children.
Design:
Case report.
Setting:
A tertiary pediatric intensive care unit (ICU).
Patients:
A single patient admitted to the ICU.
Interventions:
None.
Measurements And Main Results:
A formal brain death examination was performed on a 4-yr-old male with a diagnosis of acute pilocytic astrocytoma and global cerebral hypoxic ischemic damage secondary to a cardiorespiratory arrest. The patient fulfilled all criteria for brain death, except the apnea test. An apnea test was performed for 9 mins 23 secs, at which time, spontaneous respiratory effort was noted. The respiratory efforts were initiated with a pH of 7.08 and a PaCO2 of 91 torr (12.1 kPa).
Conclusion:
This case report suggests that current guidelines for apnea testing may lead to erroneous evaluation of medullary-respiratory drive.
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