• Linlin Fan, Wei Li, Ran Du, Yajuan Hu, Wenchen Li, Wenhao Zhu, Lei Zhang, Yingying Su, and Brain Injury Evaluation Quality Control Center of National Health Commission.
• Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China.
• J. Cardiothorac. Vasc. Anesth. 2024 Apr 1; 38 (4): 100610101006-1010.

ObjectiveTo study the influence of the initial partial pressure of carbon dioxide (PaCO2) and frequency of blood gas analyses on the positivity rate and safety of apnea testing (AT).DesignA prospective multicenter cohort study.SettingSeven teaching hospitals.ParticipantsA total of 55 patients who underwent AT.InterventionsPatients were divided into 2 groups according to their initial PaCO2-the experimental group (≥40 mmHg, 27 patients) and the control group (<40 mmHg, 28 patients). Blood gas analysis was performed at 3, 5, and 8 minutes, and vital signs were taken. AT results and complications were compared between the groups.ResultsThe initial PaCO2 of the experimental group was 42.8 ± 2.2 mmHg v 36.4 ± 2.9 mmHg in the controls. The AT positivity rate was 100%. The experimental group needed less time to reach the target PaCO2 than the control group (4.07 ± 1.27 minutes v 5.68 ± 2.06 minutes; p = 0.001). Twenty-six patients (96.3%) in the experimental group reached the target PaCO2 in 5 minutes v 17 in the control group (60.7%) (p = 0.001). Seven patients (12.7%) were unable to complete 8-minute disconnection due to hypotension. The experimental group had a slightly lower incidence of hypotension than the control group, but there was no statistical difference (7.4% v 17.9%, p = 0.245).ConclusionIncreasing the baseline PaCO2 and doing more blood gas analyses can significantly shorten the time needed for AT and improve the AT positivity rate.Copyright © 2023 Elsevier Inc. All rights reserved.

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