• Journal of critical care · Apr 2018

    Apnea testing using the oxygen insufflation method for diagnosis of brain death may compromise pulmonary function.

    • Joanna Sołek-Pastuszka, Marcin Sawicki, Waldemar Iwańczuk, Klaudyna Kojder, Wojciech Saucha, Zenon Czajkowski, Kornel Chełstowski, and Romuald Bohatyrewicz.
    • Department of Anaesthesiology and Intensive Care, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1 Street, 71-252 Szczecin, Poland. Electronic address: pastuszka@mp.pl.
    • J Crit Care. 2018 Apr 1; 44: 175-178.

    IntroductionThe aim of our study was to compare the reliability and safety of the classical I-AT with the continuous positive airway pressure apnea test (CPAP-AT).Material And MethodsIn the group of 48 patients (group O), an I-AT was performed at the end of BD diagnostic procedures, and approximately 1-1.5h later CPAP-AT with 100% FiO2 and CPAP of 10cm H2O, provided by ventilator in CPAP mode. After pre‑oxygenation with 100% FiO2 for 10min, the PaO2/FiO2 ratio was recorded prior to I-AT at time-point one (T1) and prior to CPAP-AT at time-point two (T2). Group O was categorized into subgroup N-H (non-hypoxemic), consisting of 41 patients with good lung function, and subgroup H (hypoxemic) consisting of 7 patients with poor lung function. Within each subgroup PaO2/FiO2 at T1 and T2 were compared.ResultsIn Group O, PaO2/FiO2 decreased from 321±128mmHg at T1 to 291±119mmHg at T2 (p=0.004). In subgroup N-H, PaO2/FiO2 declined from 355±103 to 321±100mmHg (p=0.008), and in subgroup H, PaO2/FiO2 remained almost unchanged. Additionally, in 4 patients from subgroup N-H, PaO2/FiO2 decreased below 200mmHg at T2.ConclusionsOur study indicates that I-AT may compromise pulmonary function and this may support the recommendation of safer CPAP-AT alternative.Copyright © 2017 Elsevier Inc. All rights reserved.

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