Fernández Ceballos I, Ems J, Steinberg E, Nuñez Silveira JM, Hornos MB, Berdiñas Anfuso M, Videla C, Ciarrocchi NM, Carboni Bisso I, Las Heras M. Pulmonary strain and end-expiratory lung volume during apnea test: a comparative analysis using electrical impedance tomography.
Medicina (B Aires) 2024;
84:359-363. [PMID:
38683525]
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Abstract
The apnea test, employed for brain death assessment, aims to demonstrate the absence of respiratory drive due to hypercapnia. The tracheal oxygen insufflation apnea test mode (I-AT) involves disconnecting the patient from invasive mechanical ventilation (iMV) for approximately 8 minutes while maintaining oxygenation. This test supports the diagnosis of brain death based on a specified increase in PaCO2. Common complications include hypoxemia and hemodynamic instability, and lung collapse-induced reduction in end-expiratory lung volume (EELV). In our case series utilizing electrical impedance tomography (EIT), we observed that continuous positive airway pressure during the apnea test (CPAP-AT) effectively mitigated lung collapse. This resulted in improved pulmonary strain compared to the disconnection of iMV. These findings suggest the potential benefits of routine CPAP-AT, particularly for potential lung donors, emphasizing the relevance of our study in providing quantitative insights into EELV loss and its association with pulmonary strain and potential lung injury.
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