Apnea testing for brain death in severe acute respiratory distress syndrome: a possible solution.
BACKGROUND
A 42-year-old man with a subarachnoid hemorrhage complicated by anoxic brain injury, respiratory failure requiring mechanical ventilation, and severe acute respiratory distress syndrome (ARDS) presented a clinical conundrum for safe apnea testing in brain death determination due to profound hypoxemia.


METHODS
Case report.


RESULTS
During brain death examination, despite meeting criteria for severe ARDS, apnea testing was successfully completed with the use of a pretest recruitment maneuver and 20 cm H(2)O CPAP valve.


CONCLUSIONS
A recruitment maneuver and CPAP valve may be used in severe ARDS for safe apnea testing in brain death determination.
Division of Critical Care Neurology, Mayo W8-B, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA, hocker.sara@mayo.edu.
Sara
S
Hocker
Francis
F
Whalen
Eelco F M
EF
Wijdicks
D000328:Adult; D001049:Apnea / Q000175:diagnosis*; D001926:Brain Death / Q000175:diagnosis*; D001930:Brain Injuries / Q000150:complications / Q000209:etiology; D006801:Humans; D000860:Hypoxia / Q000150:complications; D008297:Male; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology*; D045169:Severe Acute Respiratory Syndrome