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Effect of recruitment maneuver on hypoxemia during apnea test: after or before?

Critical Care201216:469

  • Published:


  • Oxygen
  • Public Health
  • Dioxide
  • Animal Model
  • Carbon Dioxide

We read with interest the article entitled 'Benefit of a single recruitment maneuver after an apnea test for the diagnosis of brain death' by Paries and colleagues [1].

The 'ideal' apnea test (AT) should permit an increase in PaCO2 (partial pressure of carbon dioxide in arterial blood) but prevent a detrimental decrease in PaO2 (partial pressure of oxygen in arterial blood). We agree that a recruitment maneuver (RM) after the AT can improve oxygenation and result in protection of donor organs. However, we have two comments.

First, changes in PaCO2 are not reported in the article. It has been shown that RM can affect CO2 elimination in different ways [2]. We think that the course of - already elevated - PaCO2 after RM would be of interest, and may also have clinical consequences. The structure of the study is appropriate to report the changes in PaCO2.

Second, we have shown in an animal model that a RM prior to AT followed by apneic oxygenation was associated with an increase in PaO2 without affecting the increase in PaCO2[3]. RM plus apneic oxygenation also improved the survival time during AT, and there was no change in PaCO2 (which is a warranted result).

We think that the 'optimal' method for the AT should also consider changes in PaCO2. A RM before (likewise after) the AT could prevent hypoxemia. Whether a 'combination' of RM's before and after the AT would have additive effects should also be examined in further clinical studies.



apnea test


partial pressure of carbon dioxide in arterial blood


partial pressure of oxygen in arterial blood


recruitment maneuver.


Authors’ Affiliations

Department of Anesthesiology, Istanbul University, Istanbul Medical Faculty, Capa-Fatih, 34093 Istanbul, Turkey


  1. Paries M, Boccheciampe N, Raux M, Riou B, Langeron O, Nicolas-Robin A: Benefit of a single recruitment maneuver after an apnea test for the diagnosis of brain death. Crit Care 2012, 16: R116. 10.1186/cc11408PubMed CentralView ArticlePubMedGoogle Scholar
  2. Tusman G, Bohm SH, Suarez-Sipmann F, Scandurra A, Hedenstierna G: Lung recruitment and positive end-expiratory pressure have different effects on CO2 elimination in healthy and sick lungs. Anesth Analg 2010, 111: 968-977.PubMedGoogle Scholar
  3. Senturk E, Tanju S, Ziyade S, Ozcan PE, Tugrul S, Cakar N: A recruitment maneuver improves apneic oxygenation. Minerva Anestesiol 2011, 77: 598-603.PubMedGoogle Scholar


© BioMed Central Ltd 2012