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. 2022 Jul 28;17(7):e0272086.
doi: 10.1371/journal.pone.0272086. eCollection 2022.

Optimal duration of the apnea test for determining brain death: Benefit of the short-term apnea test

Seung Min Baik  1   2 , Jin Park  3 , Tae Yoon Kim  4 , Kyung Sook Hong  4
Affiliations

Optimal duration of the apnea test for determining brain death: Benefit of the short-term apnea test

Seung Min Baik et al. PLoS One. .

Abstract

Background: The criteria for brain death determination have not been unified globally, and there is no global consensus on the apnea test, which is essential for determining brain death. Since the apnea test is associated with many complications, we aimed to determine an optimal duration of the apnea test.

Methods: We analyzed the results of the apnea test performed for brain death determination between August 2013 and February 2021 at a single institution in South Korea. Elevations in the partial pressure of carbon dioxide and mean arterial blood pressure fluctuations over time in the apnea test were recorded.

Results: In the 1st and 2nd tests, the mean partial pressure of carbon dioxide increased by more than 20 mmHg at 3 min after the apnea test compared to before the test (P < 0.05). At 4 min in the 1st test and 5 min in the 2nd test, the partial pressure of carbon dioxide exceeded 60 mmHg (P < 0.05). The fluctuation in the mean arterial blood pressure observed for 5 min during the apnea test was not significant. There was no significant fluctuation in the mean arterial blood pressure over time in the apnea test between patients with normal chest radiography findings and those with abnormal chest radiography findings (P = 0.888).

Conclusions: Our study proposes that a short-term apnea test protocol is valid for the preservation of organs for donation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Increase in the partial pressure of carbon dioxide (PaCO2) in the apnea test.
(A) At 3 min in the 1st apnea test, the PaCO2 level was above 60 mmHg. (B) At 4 min in the 2nd apnea test, the PaCO2 level was above 60 mmHg. The apnea test positive criterion is PaCO2 > 50 mmHg in South Korea, and PaCO2 > 60 mmHg according to the American Academy of Neurology (AAN) guidelines. The dotted line denotes the apnea test positive criterion according to the AAN guidelines.
Fig 2
Fig 2. Serial change in partial pressure of oxygen (PaO2).
(A) Serial changes in PaO2 were significant in the 1st apnea test (P < 0.05). (B) Serial changes in PaO2 were not significant in the 2nd apnea test (P = 0.095).
Fig 3
Fig 3. Difference in mean arterial blood pressure fluctuation during the apnea test according to chest radiography findings.
The difference in mean arterial blood pressure fluctuations between the two groups was not significant (P = 0.888).
See this image and copyright information in PMC

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Grants and funding

The author(s) received no specific funding for this work.