Brain Death! and the Apnea Test
High Yield Review - Brain Death and the Apnea Test
Case: A 60 year old male admitted to the ICU for
left sided intracerebral hemorrhage, you observe that there are no spontaneous breaths and you suspect brain death.
You assess for clinical criteria:
- He has no spontaneous respirations
- Sedation has been stopped
- You review his CT Head and it shows a catastrophic CNS event
( Left Sided Intracerebral hemorrhage )
- You note his systolic blood pressure is > 100 mmhg
- You note his core temperature is > 36C, 97F
- Review of toxicology show no drugs or poisons
You perform a Neuro exam:
- You feel for breath on your cheek and observe for chest rises and no spontaneous respirations noted
- There is no response to voice, pain, or other stimuli
- You see that the pupils are dilated and non reactive to light
- You place Ice water in the ear and the eyes do not move
- You briskly turn his head side to side and his eyes remain centered
- There is no corneal reflex
You then perform the Apnea Test
- After 10 minutes of observation you observe no spontaneous respirations
- a repeat ABG shows PaCO2 of 60 mmhg
- You then Reassess Clinical Criteria and perform another Neuro Exam
- Then you can declare brain death
Case Clues - Brain Death and the Apnea Test
- The patient has suffered an catastrophic CNS event ( Intracerebral hemorrhage)
- No spontaneous respirations noted ( so now you are thinking of brain death)
- You asses clinical criteria --> Neuro Exam --> Perform the Apnea test --> Note the ABG Results --> Repeat Clinical Criteria and Neuro exam ==> Declare Brain Death
Notable Notes - Brain Death and the Apnea Test
(Click image to open PDF)
Know it for the Boards - Brain Death and the Apnea Test!
- Apnea test protocol is observation over 10 minutes
- A positive apnea test: No respirations observed, a PaCO2 increase of 20 mmhg from baseline, or 60 mmhg
- A repeat clinical criteria and neuro assessment is needed to declare a patient brain dead
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