Regarding omitting apnea testing in a patient on vasopressors

  
NCJ_cover.jpgBy Summit Dev Bloria

First Online: 20 April 2020

This comment refers to the article available at https://doi.org/10.1007/s12028-020-00934-2 and https://doi.org/10.1007/s12028-020-00963-x.

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 [1]. 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) [1]. 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 [2]. 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 [3].

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