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English
Gil Ben-Horin
Published: Feb 16, 2017
A multicenter, population-based cohort study of consecutive apnoea tests was performed in urban centers in the province of Alberta in order to compare the conventional oxygen (O2) insufflation catheter method with use of a resuscitation bag with continuous positive airway pressure (CPAP) valve. The MetaVision clinical information system, which is used in ICUs across the province of Alberta, was used to identify consecutive apnoea tests that were performed in Calgary since introduction of the clinical information system in 2012-2013, and in Edmonton since mid-2014. The results showed that apnoea testing can be safely performed with both methods assessed in the study, including the O2 catheter technique recommended in major guideline documents. In contrast with some previous research, this study could not confirm the superiority of apnoea testing using a CPAP valve. The authors come to the following conclusions: “We believe that clinicians should perform regular arterial blood gases (ABGs) at fixed intervals of 3–5 min in order to avoid severe respiratory acidosis, and terminate the apnoea test as soon as accepted criteria for brain death are met to help avoid significant hemodynamic complications. If the O2 catheter method is used, limiting flow rate to no more than 6–8 L/min may minimise the risk of pneumothorax and avoid any carbon dioxide (CO2) elimination that could conceivably slow the rise of arterial partial pressure of carbon dioxide (PCO2) in some patients.”
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