title: Increased apnea threshold in a pediatric patient with suspected brain death.
abstract: 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.
authors.affiliation: Department of Critical Care, Children's National Medical Center, Washington, DC, USA.
authors.forename: R
authors.initials: R
authors.lastname: Vardis
authors.forename: M M
authors.initials: MM
authors.lastname: Pollack
mesh_terms: 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