Increased apnea threshold in a pediatric patient with suspected brain death.
OBJECTIVE
To evaluate the current standards for apnea testing in the evaluation of brain death in children.


METHODS
Case report.


METHODS
A tertiary pediatric intensive care unit (ICU).


METHODS
A single patient admitted to the ICU.


METHODS
None.


RESULTS
A formal brain death examination was performed on a 4-yr-old male with a diagnosis of acute pilocytic astrocytoma and global cerebral hypoxic ischemic damage secondary to a cardiorespiratory arrest. The patient fulfilled all criteria for brain death, except the apnea test. An apnea test was performed for 9 mins 23 secs, at which time, spontaneous respiratory effort was noted. The respiratory efforts were initiated with a pH of 7.08 and a PaCO2 of 91 torr (12.1 kPa).


CONCLUSIONS
This case report suggests that current guidelines for apnea testing may lead to erroneous evaluation of medullary-respiratory drive.
Vardis
R
R
Department of Critical Care, Children's National Medical Center, Washington, DC, USA.
Pollack
M M
MM
D001049:Apnea / Q000175:diagnosis* / Q000503:physiopathology; D001254:Astrocytoma / Q000503:physiopathology; D001926:Brain Death / Q000175:diagnosis* / Q000503:physiopathology; D002545:Brain Ischemia / Q000503:physiopathology; D001932:Brain Neoplasms / Q000503:physiopathology; D002675:Child, Preschool; D003951:Diagnostic Errors; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology; D008297:Male; D013997:Time Factors