Tension Pneumothorax During Apnea Testing for the Determination of Brain Death

  • Muhammad Osama Department of Medicine, Holy Family Hospital and Rawalpindi Medical University
  • Waqar Anwar Department of Medicine, Holy Family Hospital and Rawalpindi Medical University
  • Muhammad Tauseef Dildar Department of Medicine, Holy Family Hospital and Rawalpindi Medical University
  • Abrar Akbar Department of Medicine, Holy Family Hospital and Rawalpindi Medical University
  • Arfat Khalid Department of Medicine, Holy Family Hospital and Rawalpindi Medical University
  • Arslan Shehzad Department of Medicine, Holy Family Hospital and Rawalpindi Medical University
  • Muhammad Umar Department of Medicine, Holy Family Hospital and Rawalpindi Medical University
  • Muhammad Khurram Department of Medicine, Holy Family Hospital and Rawalpindi Medical University

Abstract

The apnea test (AT) is considered as the ‘condition sine
qua non’ by most of the intesivists for determining
brain death (BD) as it provides an important
information for a definitive loss of brainstem function.
It is the most difficult clinical test in BD protocols and
is also potentially harmful and lengthy. The possible
complications of this test include severe decrease in
blood pressure, pneumothorax, excessive CO2 retention,
hypoxia, acidosis, and cardiac arrhythmia or asystole.
It is important to abort the test in the setting of any of
the above mentioned complication, which will
compromise BD diagnosis. It is important to ensure
that certain prerequisites are satisfied before the AT is
carried out. These include body temperature 32°C or
more, normal PO2 or preoxygenation to obtain an
arterial PO2 ≥ 200 mmHg, arterial PCO2 or
PaCO2 normal or above 40 mmH, blood pH normal or
in the low basic range, pretest systolic blood pressure
of at least 90 mmHg, Euvolemia or a positive fluid
balance during the previous 6 hours, no drug that can
paralyze the respiratory muscles. If continuous or
intermittent oxygen supply is preceded by decreasing
nitrogen levels of blood gases, high PaO2 levels can be
maintained for very long periods of time.
Preoxygenation removes alveolar nitrogen stores and
helps oxygen transport. There are several techniques
for ascertaining that there is sufficient oxygenation
during AT .1-5

Published
2018-03-30
How to Cite
Osama, M., Anwar, W., Dildar, M. T., Akbar, A., Khalid, A., Shehzad, A., Umar, M., & Khurram, M. (2018). Tension Pneumothorax During Apnea Testing for the Determination of Brain Death. Journal of Rawalpindi Medical College, 87-89. Retrieved from http://journalrmc.com/index.php/JRMC/article/view/856