Apnea test for determination of clinical brain



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APNEA TEST FOR DETERMINATION OF CLINICAL BRAIN 

DEATH 

 

It is recommended that the apnea test be performed as follows: 



 

1. Prerequisites: 

 



 

 



 

Core 



Temperature 

  36.5


°

C or 97


°

Systolic blood pressure  



 

90 mm Hg 

Corrected diabetes insipidus (Positive fluid balance) 

Normal 


PCO

2

 (Arterial PCO



2

 of 35-45 mm Hg) 

   


2.  Preoxygenate with 100% O

2

 for 30 minutes 



 

3.  Connect a pulse oximeter and disconnect the ventilator 

 

4.  Place a nasal cannula at the level of the carina and deliver 100% O



2

, 8 L per 

minute 

 

5.  Look closely for respiratory movements (abdominal or chest excursions that 



produce adequate tidal volumes) 

 

6. Measure PO



2

, PCO


2

, and pH after 10 minutes and reconnect the ventilator 

 

7. If respiratory movements are absent and arterial PCO



2

 is 60 mm Hg (option: 

20 mm Hg increase in PCO

2

 over a baseline normal PCO



2

), the apnea test 

result is positive (supports the diagnosis of brain death) 

 

Connect the ventilator if during testing the systolic blood pressure 



becomes < 90 mm Hg or the pulse oximeter indicates significant 

desaturation and cardiac arrhythmias are present: immediately draw 

an arterial blood sample and analyze ABG! 

 

8. If PCO



2

 is 60 mm Hg or PCO

2

 increase is > 20 mm Hg over baseline normal 



PCO

2

, the apnea test is positive [supports the clinical diagnosis of brain 



death] 

 

9. If the PCO



2

 is < 60 mm Hg or PCO



2

 increase is < 20 mm Hg over baseline 

normal  PCO

2

, the result is indeterminate and an additional confirmatory test 

can be considered. 

Summary of the American Academy of Neurology Practice for determining Brain Death in Adults 



 

 

© 2001 



 

 


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