Korean J Anesthesiol.  2014 Sep;67(3):186-192. 10.4097/kjae.2014.67.3.186.

The usefulness of end-tidal carbon dioxide monitoring during apnea test in brain-dead patients

• Kim HY
• Kim GS
• Shin YH
• Cha SR

• KMID: 1966753
• DOI: http://doi.org/10.4097/kjae.2014.67.3.186

Abstract

BACKGROUND
The apnea test (AT) is essential to confirming the diagnosis of brain death, but critical complications can occur if the AT is maintained over a long period. To minimize the AT period, we used end-tidal carbon dioxide (ETCO2) monitoring because ETCO2 is closely correlated with partial pressure of arterial carbon dioxide (PaCO2). The aim of the present study is to evaluate the usefulness of ETCO2 monitoring during apnea testing.
METHODS
We reviewed 61 patients who were pronounced brain dead at our hospital from July 2009 to December 2012. The subjects were divided into two groups: the N-group, in which capnography was not used, and the C-group, in which capnography was used to monitor ETCO2. In the C-group, whenever arterial blood was sampled, the PaCO2 - ETCO2 gradients were calculated and the ventilator setting adjusted to maintain normocapnia prior to apnea testing.
RESULTS
Twenty-eight subjects in the N-group and twenty-nine subjects in the C-group were included. The gender ratio, age, and cause of brain death were not different between the two groups. Prior to the AT, the normocapnia ratio was higher in the C-group than in the N-group. During the AT, the total test period was shorter in the C-group. Moreover, systolic blood pressure increased in the C-group and decreased in the N-group during apnea testing.
CONCLUSIONS
ETCO2 monitoring during AT allows the PaCO2 level to be predicted, which reduces the duration of the test and stabilizes systolic blood pressure. Thus, with ETCO2 monitoring, the AT can be fast and safe.

Keyword

Apnea; Blood gas analysis; Brain death; Capnography; Carbon dioxide

MeSH Terms

Apnea*
Blood Gas Analysis
Blood Pressure
Brain Death
Capnography
Carbon Dioxide*
Diagnosis
Humans
Partial Pressure
Ventilators, Mechanical
Carbon Dioxide