The usefulness of end-tidal carbon dioxide monitoring during apnea test in brain-dead patients

BACKGROUND: The apnea test (AT) is essential to confirming the diagnosis of brain death, but critical complications can occur if the AT is maintained over a long period. To minimize the AT period, we used end-tidal carbon dioxide (ETCO(2)) monitoring because ETCO(2) is closely correlated with partial pressure of arterial carbon dioxide (PaCO(2)). The aim of the present study is to evaluate the usefulness of ETCO(2) monitoring during apnea testing. METHODS: We reviewed 61 patients who were pronounced brain dead at our hospital from July 2009 to December 2012. The subjects were divided into two groups: the N-group, in which capnography was not used, and the C-group, in which capnography was used to monitor ETCO(2). In the C-group, whenever arterial blood was sampled, the PaCO(2) - ETCO(2) gradients were calculated and the ventilator setting adjusted to maintain normocapnia prior to apnea testing. RESULTS: Twenty-eight subjects in the N-group and twenty-nine subjects in the C-group were included. The gender ratio, age, and cause of brain death were not different between the two groups. Prior to the AT, the normocapnia ratio was higher in the C-group than in the N-group. During the AT, the total test period was shorter in the C-group. Moreover, systolic blood pressure increased in the C-group and decreased in the N-group during apnea testing. CONCLUSIONS: ETCO(2) monitoring during AT allows the PaCO(2) level to be predicted, which reduces the duration of the test and stabilizes systolic blood pressure. Thus, with ETCO(2) monitoring, the AT can be fast and safe.