We read with interest the article by Latorre et al. and congratulate the authors for highlighting a very relevant observation concerning a very contentious field in neurocritical care . We would, however, like to enquire to them regarding their reason for not attempting an apnea test in their patient. As has been highlighted in Appendix-1 of the said article, a systolic blood pressure (BP) of ≥ 100 mm Hg and a mean BP > 65 mmHg are prerequisites for brain death (BD) evaluation in a patient. Although their patient was on two vasopressors, we assume the patient was normotensive, considering the fact that clinical evaluation for possible BD was completed in him. In such a scenario, I believe that he was fulfilling the prerequisites for apnea testing (again, Appendix-1, Table B—prerequisites for apnea testing) . And if indeed the patient was hypotensive, he should have not been considered for brain death evaluation prior to correcting his hypotension.
The apnea test is a conclusive test for determination of BD. Although there have been questions raised regarding the safety of apnea testing, it has been shown that when performed properly, apnea test is a safe procedure . As far as the role of SPECT in BD diagnosis goes, it has been reported that a patient who had already been declared as BD did show faint traces of uptake .