Retrospective Evaluation of Apnea Testing in Brain Dead Children
DOI:
https://doi.org/10.1007/s13546-016-1222-3Keywords:
Hydrocephalus, Elevated intracranial pressure, External ventricular drainage, Nursing careAbstract
Introduction : Apnea testing (AT) is mandatory for diagnosing brain death (BD). Conventional AT for children is similar to adult conventional recommendation. However, neither efficiency nor tolerance of AT with removal from ventilator support was ever evaluated on strictly pediatric population.
Materials : In this retrospective single-center study, all the patients who presented a suspected clinical status of BD from 2005 to 2014 and who have undergone AT were included. AT realized with removal from ventilator support were considered completed when no spontaneous respiratory movement was observed until the value of PaCO2 reached 60 mmHg. The main endpoint was the number of achieved AT, with compared analysis between groups of children under 2 years and over 2 years. Secondary endpoints were the occurrence of sudden complications or evolution of respiratory or hemodynamic parameters.
Results : Among 103 patients with suspected clinical BD, only 43 had at least one AT, which were completed in 40 cases. Transcranial Doppler observed a cerebral circulatory arrest in 100% of patients. There was no difference with regard to the incidence of achieved AT between brain dead children under 2 years (13 out of 15; 87%) and those over 2 years (27 out of 28; 96%; P = 0.3). Pneumothorax, arrhythmia, or cardiac arrest was never observed. PaCO2 significantly increased in all patients during AT (37 ± 8 vs 76 ± 14 mmHg; P < 0.0001) resulting in a significant decrease of pH (7.37 ± 0.08 vs 7.12 ± 0.09; P < 0,0001). On the other hand, a decrease of PaO2 induced a significant decrease of the PaO2/FiO2 ratio (276 ± 126 before AT vs 179 ± 120 after AT; P = 0.0002), resulting in a reduction from 44% to 16% of potential lung donors (P = 0.0066). A few hours after AT was performed, the percentage of potential lung donors who recovered was 36%.
Conclusion : AT realized with removal of ventilation support can be performed on children of all ages and it was found to be efficient in determining BD; however, it was found that AT was responsible of causing severe homeostasis deterioration. Decrease of arterial pH and PaO2/FiO2 ratio induced deleterious conditions for potential donor grafts.
