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Table 4 Apnea test safety considerations [10, 15, 18]

From: Quality improvement in the determination of death by neurologic criteria around the world

Complication

Prevention techniques

Hypotension

Ensure MAP > 60 mmHg or SBP > 100 mmHg before testing is initiated

Use fluids/vasopressors/inotropes as needed

Ensure euvolemia/hypervolemia prior to testing

Ensure temperature is > 36 °C

Abort testing for MAP < 60 mmHg or SBP < 100 mmHg

Hypoxemia

Preoxygenate with 100% oxygen for 10-min prior to testing

Consider checking arterial blood gas to ensure PaO2 > 200 mmHg

Consider use of CPAP or a PEEP valve

Abort testing for sustained desaturation < 85%

Pneumothorax, pneumomediastinum, and pneumoperitoneum

Ensure insufflation catheter tip is in the distal third of the endotracheal tube

Ensure insufflation catheter is not too wide compared to the diameter of the endotracheal tube

Minimize oxygen flow rate through insufflation catheter

Arrhythmia/cardiac arrest

Prevent hypotension and hypoxemia

Correct electrolyte derangements

Ensure temperature is > 36 °C

  1. MAP Mean arterial pressure, SBP Systolic blood pressure, CPAP continuous positive airway pressure, PEEP Positive end-expiratory pressure