The apnea test: Rationale, confounders, and criticism

Journal of Child Neurology

Volumn 25, Issue 11, 2010, Pages 1435-1443

  Joffe, Ari R ^a   Anton, Natalie R ^a   Duff, Jonathan P ^a  

^a UNIVERSITY OF ALBERTA   (Canada)

Author keywords

apnea; brain death; carbon dioxide; endocrine; respiration

Indexed keywords

APNEA; ARTERIAL CARBON DIOXIDE TENSION; ARTICLE; BRAIN DEATH; BREATHING; CERVICAL SPINAL CORD INJURY; HUMAN; HYPEROXIA; INTRACRANIAL PRESSURE; LUNG FUNCTION TEST; PHYSIOLOGY; PRESSURE; PRIORITY JOURNAL; THE APNEA TEST;

APNEA; BRAIN DEATH; HUMANS; RESPIRATORY CENTER;

EID: 78650223621     PISSN: 08830738     EISSN: 17088283     Source Type: Journal    
DOI: 10.1177/0883073810369380     Document Type: Article

References (85)

1. Shemie SD, Doig C., Dickens B., et al. Severe brain injury to neurological determination of death: Canadian forum recommendations. CMAJ. 2006 ; 174: S1 - S12.
2. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Practice parameters for determining brain death in adults. Neurology. 1995 ; 45: 1012-1014.
3. Wijdicks EFM. Determining brain death in adults. Neurology. 1995 ; 45: 1003-1011.
4. Lang CJG, Heckmann JG Apnea testing for the diagnosis of brain death. Lancet Neurol. 2005 ; 112: 358-369.
5. Shemie S. Diagnosis of brain death in children: technology and the inadequate lexicon of death. Lancet. 2007 ; 6: 87-88.
6. Molinari GF The NINCS Collaborative study of brain death: a historical perspective. In: Walker E, ed. The NINCDS Collaborative Study of Brain Death. Bethesda, MD: US Department of Health and Human Services; 1980: 1-32.
7. Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death. A definition of irreversible coma. JAMA. 1968 ; 205: 85-88.
8. Jennett B., Gleave J., Wilson P. Brain death in three neurosurgical units. BMJ. 1981 ; 282: 533-539.
9. Stevens RD, Dowdy DW, Michaels RK, et al. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med. 2007 ; 33: 1876-1891.
10. Australian and New Zealand Intensive Care Society. In: The ANZICS Statement on Death and Organ Donation. 3rd ed. Melbourne: ANZICS ; 2008.
11. Academy of Medical Royal Colleges. A Code of Practice For the Diagnosis and Confirmation of Death. London: PPG Design and Print Ltd ; 2008. http://www.aomrc.org.uk/aomrc/admin/reports/docs/DofD-final.pdf. Accessed February 18, 2010.
12. Yang KL, Dantzker DR Reversible brain death: a manifestation of amitriptyline overdose. Chest. 1991 ; 99: 1037-1038.
13. Auinger K., Muller V., Rudiger A., Maggiorini M. Valproic acid intoxication imitating brain death. Am J Emerg Med. 2009 ; 27: e5 - e6.
14. Oldenhof H., de Jong M., Steenhoek A., Janknegt R. Clinical pharmacokinetics of midazolam in intensive care patients, a wide interpatient variability? Clin Pharmacol Ther. 1988 ; 43: 263-269.
15. Meinitzer A., Zink M., Marz W., et al. Midazolam and its metabolites in brain death diagnosis. Int J Clin Pharmacol Therapeut. 2005 ; 43: 517-526.
16. Peters FT, Jung J., Kraemer T., Maurer HH Fast, simple, and validated gas chromatographic-mass spectrometric assay for quantification of drugs relevant to diagnosis of brain death in human blood plasma samples. Ther Drug Monit. 2005 ; 27: 334-344.
17. Joffe AR, Anton N., Blackwood J. Brain death and the cervical spinal cord: a confounding factor for the clinical examination. Spinal Cord. 2010 ; 48: 2-9.
18. Walker AE Neuropathological findings in the brains of patients admitted to the collaborative study. In: Walker AE, ed. The NINCDS Collaborative Study of Brain Death. Bethesda, MD: US Department of Health and Human Services; 1980: 33-76.
19. Schneider H., Matakas F. Pathological changes of the spinal cord after brain death. Acta Neuropath (Berl). 1971 ; 18: 234-247.
20. Matakas F., Cervos-Navarro J., Schneider H. Experimental brain death: morphology and fine structure of the brain. J Neurol Neurosurg Psychiatr. 1973 ; 36: 497-508.
21. Joffe AR, Lequier L., Cave D. Specificity of radionuclide brain blood flow testing in brain death: case report and review. J Intensive Care Med. 2010 ; 25: 53-64.
22. Coimbra CG Are "brain dead" (or "brain-stem dead") patients neurologically recoverable? In: deMattei R, Byrne P, eds. Finis Vitae: Brain Death Is Not True Death. Oregon, OH: Life Guardian Foundation; 2009: 313-378.
23. Shemie SD, Ross H., Pagliarello J., et al. Organ donor management in Canada: recommendations of the forum on medical management to optimize donor organ potential. CMAJ. 2006 ; 174: S13 - S30.
24. Dictus C., Vienenkoetter B., Esmaeilzadeh M., et al. Critical care management of potential organ donors: our current standard. Clin Transplant. 2009 ; 23: S2 - S9.
25. Massumi RA, Winnacker JL Severe depression of the respiratory center in myxedema. Am J Med. 1964 ; 36: 876-882.
26. Zwillich CW, Pierson DJ, Hofeldt FD, et al. Ventilatory control in myxedema and hypothyroidism. N Engl J Med. 1975 ; 292: 662-665.
27. Domm BM, Vassallo CL Myxedema coma with respiratory failure. Am Rev Resp Dis. 1973 ; 107: 842-845.
28. Lumb A. Changes in the carbon dioxide tension. In: Lumb A, ed. Nunn's Applied Respiratory Physiology. 5th ed. Oxford: Butterworth-Heinemann ; 2000: 460-471.
29. Tibballs J. A critique of the apneic oxygenation test for the diagnosis of "brain death." Pediatr Critical Care Med. 2010. [Epub ahead of print: DOI 10.1097/PCC.0b013e3181ce75dd.].
30. Vardis RV, Pollack MM Increased apnea threshold in a pediatric patient with suspected brain death. Crit Care Med. 1998 ; 26: 1917-1919.
31. Brilli RJ, Bigos D. Increased apnea threshold in a pediatric patient with suspected brain death. J Child Neurol. 1995 ; 10: 245-246.
32. Hahn SE, Tobias JD, Deshpande JK Apnea testing in the determination of brain death: is it reliable ? Clin Intensive Care. 1991 ; 2: 182-184.
33. Joffe AR, Kolski H., Duff J., deCaen A. A 10-month-old infant with reversible findings of brain death. Pediatr Neurol. 2009 ; 41: 378-382.
34. Okamoto K., Sugimoto T. Return of spontaneous respiration in an infant who fulfilled current criteria to determine brain death. Pediatrics. 1995 ; 96: 518-520.
35. Wijdicks EFM, Rabinstein AA, Manno EM, Atkinson JD Pronouncing brain death: contemporary practice and safety of the apnea test. Neurology. 2008 ; 71: 1240-1244.
36. Bratton SL, Chestnut RM, Ghajar J., et al. Blood pressure and oxygenation. J Neurotrauma. 2007 ; 24: S7 - S13.
37. Brian JE Carbon dioxide and the cerebral circulation. Anesthesiology. 1998 ; 88: 1365-1386.
38. Bratton SL, Chestnut RM, Ghajar J., Hammond FFM, et al. Hyperventilation. J Neurotrauma. 2007 ; 24: S87 - S90.
39. Cantu RC, Ames A., Dixon J., DiGiacinto G. Reversibility of experimental cerebrovascular obstruction induced by complete ischemia. J Neurosurg. 1969 ; 31: 429-431.
40. Lewelt W., Jenkins LW, Miller JD Autoregulation of cerebral blood flow after experimental fluid percussion injury of the brain. J Neurosurg. 1980 ; 53: 500-511.
41. Coimbra CG Implications of ischemic penumbra for the diagnosis of brain death. Braz J Med Biol Res. 1999 ; 32: 1479-1487.
42. Butcher K., Emery D. Acute stroke imaging part II: the ischemic penumbra. Can J Neurol Sci. 2010 ; 37: 17-27.
43. Latchaw RE, Alberts MJ, Lev MH, et al. Recommendations for imaging of acute ischemic stroke: a scientific statement from the American Heart Association. Stroke. 2009 ; 40: 3646-3678.
44. Joffe AR Are recent defenses of the brain death concept adequate ? Bioethics. 2010 ; 24: 47-53.
45. Joffe AR Limitation of brain death in the interpretation of computed tomographic angiography. Intensive Care Med. 2007 ; 33: 2218.
46. Feldman JL, Del Negro CA Looking for inspiration: new perspectives on respiratory rhythm. Nat Rev Neurosci. 2007 ; 7: 232-242.
47. Feldman JL, Mitchell GS, Nattie EE Breathing: rhythmicity, plasticity, chemosensitivity. Annu Rev Neurosci. 2003 ; 26: 239-266.
48. Feldman JL, Kam K., Janczewski WA Practice makes perfect, even for breathing. Nat Neurosci. 2009 ; 12: 961-963.
49. Gray PA, Janczewski WA, Mellen N., et al. Normal breathing requires preBötzinger complex neurokinin-1 receptor-expressing neurons. Nat Neurosci. 2001 ; 4: 927-930.
50. Tan W., Janczewski WA, Yang P., et al. Silencing preBötzinger complex somatostatin-expressing neurons induces persistent apnea in awake rat. Nat Neurosci. 2008 ; 11: 538-540.
51. Lumb A. Control of breathing. In: Lumb A, ed. Nunn's Applied Respiratory Physiology. 5th ed. Oxford: Butterworth-Heinemann ; 2000: 82-112.
52. Lloyd BB, Jukes MGM, Cunningham DJC. The relation between alveolar oxygen pressure and the respiratory response to carbon dioxide in man. Quart J Exptl Physiol. 1958 ; 43: 214-227.
53. Pattinson KTS, Mitsis GD, Harvey AK, et al. Determination of the human brainstem respiratory control network and its cortical connections in vivo using functional and structural imaging. NeuroImage. 2009 ; 44: 295-305.
54. Habre W., Sims C., D'Souza M. Anaesthetic management of children with Joubert syndrome. Paediatr Anaes. 1997 ; 7: 251-253.
55. Abdala APL, Rybak IA, Smith JC, et al. Multiple pontomedullary mechanisms of respiratory rhythmogenesis. Respir Physiol Neurobiol. 2009 ; 168: 19-25.
56. Smith JC, Abdala APL, Rybak IA, Paton JFR. Structural and functional architecture of respiratory networks in the mammalian brainstem. Phil Trans R Soc B. 2009 ; 364: 2577-2587.
57. St-John WM Noeud vital for breathing in the brainstem: gasping- yes, eupnoea-doubtful. Phil Trans R Soc B. 2009 ; 364: 2625-2633.
58. St-John WM Medullary regions for neurogenesis of gasping: noeud vital or noeuds vitals ? J Appl Physiol. 1996 ; 81: 1865-1877.
59. Pena F. Neuronal network properties underlying the generation of gasping. Clinical Exp Pharmacol Physiol. 2009 ; 36: 1218-1228.
60. Lieske SP, Thoby-Brisson M., Telgkamp P., Ramirez JM Reconfiguration of the neural network controlling multiple breathing patterns: eupnea, sighs and gasps. Nat Neurosci. 2000 ; 3: 600-607.
61. Fewell JE, Smith FG, Ng VKY, Wong VH, Wang Y. Postnatal age influences the ability of rats to autoresuscitate from hypoxic-induced apnea. Am J Physiol Regulatory Integrative Comp Physiol. 2000 ; 279: R39 - R46.
62. Thach BT Some aspects of clinical relevance in the maturation of respiratory control in infants. J Appl Physiol. 2008 ; 104: 1828-1834.
63. Sanocka UM, Donnelly DF, Haddad GG Autoresuscitation: a survival mechanism in piglets. J Appl Physiol. 1992 ; 73: 749-753.
64. Gershan WM, Jacobi MS, Thach BT Maturation of cardiorespiratory interaction in spontaneous recovery from hypoxic apnea (autoresuscitation). Pediatr Res. 1990 ; 28: 87-93.
65. Poets CF, Meny RG, Chobanian MR, Bonofiglo RE Gasping and other cardiorespiratory patterns during sudden infant deaths. Pediatr Res. 1999 ; 45: 350-354.
66. Sridhar R., Thach BT, Kelly DH, Henslee JA Characterization of successful and failed autoresuscitation in human infants, including those dying of SIDS. Pediatr Pulmonol. 2003 ; 36: 113-122.
67. Manole MD, Hickey RW Preterminal gasping and effects on cardiac function. Crit Care Med. 2006 ; 34: S438 - S441.
68. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining Death: Medical, Legal, and Ethical Issues in the Determination of Death. Washington, DC: US Government Printing Office ; 1981.
69. Bernat JL, Culver CM, Gert B. On the definition and criterion of death. Ann Intern Med. 1981 ; 94: 389-394.
70. Kamm FM Brain death and spontaneous breathing. Philos Public Aff. 2001 ; 30: 297-320.
71. Joffe AR Is there good justification for the universal medical acceptance of brain death as death. APA Newsletters. 2009 ; 9: 9-13.
72. Pallis C. On the brainstem criterion of death. In: Youngner SJ, Arnold RM, Schapiro R, eds. The Definition of Death: In Law Contemporary Controversies. Baltimore, MD: The Johns Hopkins University Press ; 1999: 93-100.
73. Shewmon DA Brainstem death, brain death, and death: a critical re-evaluation of the purported equivalence. Issues Law Med. 1998 ; 14: 125-145.
74. Joffe AR Brain death is not death: a critique of the concept, criterion, and tests of brain death. Rev Neurosci. 2009 ; 20: 187-198.
75. President's Council of Bioethics. Controversies in the Determination of Death. http://bioethicsprint.bioethics.gov/reports/death/ Controversies%20in%20the%20Determination%20of%20Death%20for%20the%20Web%20(2). pdf Accessed February 8, 2010.
76. Shewmon DA Brain death: can it be resuscitated ? Hastings Cent Rep. 2009 ; 39: 18-24.
77. Joffe AR The ethics of donation and transplantation: are definitions of death being distorted for organ transplantation ? Phil Ethics Humanities Med. 2007 ; 2: 1-7.
78. Shewmon DA The brain and somatic integration: insights into the standard biological rationale for equating brain death with death. J Med Philos. 2001 ; 26: 457-478.
79. Wijdicks EFM, Pfeifer EA Neuropathology of brain death in the modern transplant era. Neurology. 2008 ; 70: 1234-1237.
80. Walker AE Neuropathological findings in the brains of patients admitted to the collaborative study. In: Walker AE, ed. The NINCDS Collaborative Study of Brain Death. Bethesda, MD: US Department of Health and Human Services; 1980: 33-76.
81. Joffe AR The neurological determination of death: what does it really mean ? Issues Law Med. 2007 ; 23: 119-140.
82. Miller FG, Truog RD Rethinking the ethics of vital organ donations. Hastings Cent Rep. 2008 ; 38: 38-46.
83. Miller FG Death and organ donation: back to the future. J Med Ethics. 2009 ; 35: 616-620.
84. Miller FG, Truog RD, Brock DW Moral fictions and medical ethics. [published online ahead of print]. Bioethics. DOI: 10.111/ j.1467-8519.2009. 01738.x.
85. Truog RD, Robinson WM Role of brain death and the dead-donor rule in the ethics of organ transplantation. Crit Care Med. 2003 ; 31: 2391-2396.