Pulmonary strain and end-expiratory lung volume during apnea test: a comparative analysis using electrical impedance tomography

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 mainta...

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Published inMedicina Vol. 84; no. 2; p. 359
Main Authors Fernández Ceballos, Ignacio, Ems, Joaquín, Steinberg, Emilio, Nuñez Silveira, Juan M, Hornos, Micaela B, Berdiñas Anfuso, Melany, Videla, Carlos, Ciarrocchi, Nicolás M, Carboni Bisso, Indalecio, Las Heras, Marcos
Format Journal Article
LanguageEnglish
Published Argentina 01.03.2024
Subjects
Adult
Aged
Apnea - physiopathology
Brain Death - diagnosis
Brain Death - diagnostic imaging
Brain Death - physiopathology
Continuous Positive Airway Pressure
Electric Impedance
Female
Humans
Lung - diagnostic imaging
Lung - physiopathology
Lung Volume Measurements - methods
Male
Middle Aged
Tomography - methods
brain death
continuous positive pressure airway
apnea test
electrical impedance tomography
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Summary: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.
ISSN:1669-9106