{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:09:14Z","timestamp":1790708954798,"version":"4.1.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurocrit Care"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>The use of continuous positive airway pressure has been shown to improve the tolerance of the apnea test, a critical component of brain death evaluation. The ability to deactivate the apnea backup setting has made apnea testing possible using several conventional mechanical ventilators. Our goal was to evaluate the safety and efficacy of apnea testing performed on mechanical ventilation, compared with the oxygen insufflation technique, for the determination of brain death.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was a retrospective study. In 2016, our institution approved a change in policy to permit apnea testing on conventional mechanical ventilation. We examined the records of consecutive adults who underwent apnea testing as part of the brain death evaluation process between 2016 and 2022. Using an apnea test technique was decided at the discretion of the attending physician. Outcomes were successful apnea test and the occurrence of patient instability during the test. This included oxygen desaturation (SpO2)\u2009&lt;\u200990%, hypotension (mean arterial pressure\u2009&lt;\u200965\u00a0mm Hg despite titration of vasopressor), cardiac arrhythmia, pneumothorax, and cardiac arrest.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Ninety-two adult patients underwent apnea testing during the study period: 58 (63%) with mechanical ventilation, 32 (35%) with oxygen insufflation, and 2 (2%) lacked documentation of technique. Apnea tests could not be completed successfully in 3 of 92 (3%) patients\u2014two patients undergoing the oxygen insufflation technique (one patient with hypoxemia and one patient with hypotension) and one patient on mechanical ventilation (aborted for hemodynamic instability). Hypoxemia occurred in 4 of 32 (12.5%) patients with oxygen insufflation and in zero patients on mechanical ventilation (<jats:italic>p<\/jats:italic>\u2009=\u20090.01). Hypotension occurred during 3 of 58 (5%) tests with mechanical ventilation and 4 of 32 (12.5%) tests with oxygen insufflation (<jats:italic>p<\/jats:italic>\u2009=\u20090.24). In multivariate analysis, the use of oxygen insufflation was an independent predictor of patient instability during the apnea test (odds ratio 37.74, 95% confidence interval 2.74\u2013520.14).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Apnea testing on conventional mechanical ventilation is feasible and offers several potential advantages over other techniques.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s12028-024-01990-8","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T16:04:10Z","timestamp":1714061050000},"page":"426-433","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Apnea Testing on Conventional Mechanical Ventilation During Brain Death Evaluation"],"prefix":"10.1007","volume":"41","author":[{"given":"Rameez Ali","family":"Merchant","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahid Nafees","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Haddix","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig Andrew","family":"Williamson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa Lee","family":"Jacobs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun Deep","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7183-8324","authenticated-orcid":false,"given":"Venkatakrishna","family":"Rajajee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,25]]},"reference":[{"key":"1990_CR1","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1212\/WNL.0000000000207740","volume":"101","author":"DM Greer","year":"2023","unstructured":"Greer DM, Kirschen MP, Lewis A, et al. Pediatric and adult brain death\/death by neurologic criteria consensus guideline: report of the AAN Guidelines Subcommittee, AAP, CNS, and SCCM. Neurology. 2023;101:1112\u201332.","journal-title":"Neurology"},{"issue":"2","key":"1990_CR2","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1007\/s12028-020-01015-0","volume":"34","author":"KM Busl","year":"2021","unstructured":"Busl KM, Lewis A, Varelas PN. Apnea testing for the determination of brain death: a systematic scoping review. Neurocrit Care. 2021;34(2):608\u201320.","journal-title":"Neurocrit Care"},{"issue":"3","key":"1990_CR3","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1007\/s12028-014-9958-y","volume":"21","author":"S Datar","year":"2014","unstructured":"Datar S, Fugate J, Rabinstein A, Couillard P, Wijdicks EF. Completing the apnea test: decline in complications. Neurocrit Care. 2014;21(3):392\u20136.","journal-title":"Neurocrit Care"},{"issue":"11","key":"1990_CR4","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.4330\/wjc.v6.i11.1175","volume":"6","author":"T Kato","year":"2014","unstructured":"Kato T, Suda S, Kasai T. Positive airway pressure therapy for heart failure. World J Cardiol. 2014;6(11):1175\u201391.","journal-title":"World J Cardiol"},{"issue":"3","key":"1990_CR5","doi-asserted-by":"publisher","first-page":"197","DOI":"10.4103\/0972-2327.56326","volume":"12","author":"C Machado","year":"2009","unstructured":"Machado C, Perez J, Scherle C, Areu A, Pando A. Brain death diagnosis and apnea test safety. Ann Indian Acad Neurol. 2009;12(3):197\u2013200.","journal-title":"Ann Indian Acad Neurol"},{"issue":"5","key":"1990_CR6","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1097\/00000542-199811000-00027","volume":"89","author":"G Bar-Joseph","year":"1998","unstructured":"Bar-Joseph G, Bar-Lavie Y, Zonis Z. Tension pneumothorax during apnea testing for the determination of brain death. Anesthesiology. 1998;89(5):1250\u20131.","journal-title":"Anesthesiology"},{"issue":"1","key":"1990_CR7","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1007\/s12028-017-0380-0","volume":"27","author":"AH Kramer","year":"2017","unstructured":"Kramer AH, Couillard P, Bader R, et al. Prevention of hypoxemia during apnea testing: a comparison of oxygen insufflation and continuous positive airway pressure. Neurocrit Care. 2017;27(1):60\u20137.","journal-title":"Neurocrit Care"},{"issue":"8","key":"1990_CR8","doi-asserted-by":"publisher","first-page":"2213","DOI":"10.1097\/01.CCM.0000215114.46127.DA","volume":"34","author":"S Levesque","year":"2006","unstructured":"Levesque S, Lessard MR, Nicole PC, et al. Efficacy of a T-piece system and a continuous positive airway pressure system for apnea testing in the diagnosis of brain death. Crit Care Med. 2006;34(8):2213\u20136.","journal-title":"Crit Care Med"},{"issue":"2","key":"1990_CR9","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1007\/s12028-018-0608-7","volume":"30","author":"J Solek-Pastuszka","year":"2019","unstructured":"Solek-Pastuszka J, Biernawska J, Iwanczuk W, et al. Comparison of two apnea test methods, oxygen insufflation and continuous positive airway pressure during diagnosis of brain death: final report. Neurocrit Care. 2019;30(2):348\u201354.","journal-title":"Neurocrit Care"},{"issue":"11","key":"1990_CR10","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1001\/jama.2020.11586","volume":"324","author":"DM Greer","year":"2020","unstructured":"Greer DM, Shemie SD, Lewis A, et al. Determination of Brain death\/death by neurologic criteria: the world brain death project. JAMA. 2020;324(11):1078\u201397.","journal-title":"JAMA"},{"issue":"23","key":"1990_CR11","first-page":"2526","volume":"307","author":"ADT Force","year":"2012","unstructured":"Force ADT, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526\u201333.","journal-title":"JAMA"},{"issue":"19","key":"1990_CR12","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000015602","volume":"98","author":"J Park","year":"2019","unstructured":"Park J, Lee YJ, Hong KS. Proposed safe apnea test using positive end-expiratory pressure valve and short-term blood gas analysis: observational study. Medicine (Baltimore). 2019;98(19): e15602.","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"1990_CR13","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1007\/s00134-015-4105-6","volume":"42","author":"M Giani","year":"2016","unstructured":"Giani M, Scaravilli V, Colombo SM, et al. Apnea test during brain death assessment in mechanically ventilated and ECMO patients. Intensive Care Med. 2016;42(1):72\u201381.","journal-title":"Intensive Care Med"},{"issue":"12","key":"1990_CR14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105419","volume":"29","author":"Y Radaideh","year":"2020","unstructured":"Radaideh Y, Garg R, Abdalla AA, et al. Challenges in brain death determination and apnea testing for patients with COVID-19. J Stroke Cerebrovasc Dis. 2020;29(12): 105419.","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"4","key":"1990_CR15","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1016\/j.chest.2017.05.032","volume":"152","author":"RD Truog","year":"2017","unstructured":"Truog RD, Tasker RC. COUNTERPOINT: should informed consent be required for apnea testing in patients with suspected brain death? Yes. Chest. 2017;152(4):702\u20134.","journal-title":"Chest"},{"issue":"5","key":"1990_CR16","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1212\/WNL.0000000000006750","volume":"92","author":"JA Russell","year":"2019","unstructured":"Russell JA, Epstein LG, Greer DM, et al. Brain death, the determination of brain death, and member guidance for brain death accommodation requests: AAN position statement. Neurology. 2019;92(5):228\u201332.","journal-title":"Neurology"}],"container-title":["Neurocritical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12028-024-01990-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12028-024-01990-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12028-024-01990-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,10]],"date-time":"2024-12-10T23:12:32Z","timestamp":1733872352000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12028-024-01990-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,25]]},"references-count":16,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["1990"],"URL":"https:\/\/doi.org\/10.1007\/s12028-024-01990-8","relation":{},"ISSN":["1541-6933","1556-0961"],"issn-type":[{"value":"1541-6933","type":"print"},{"value":"1556-0961","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,25]]},"assertion":[{"value":"10 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 March 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 April 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"None of the authors have any conflict of interest to declare.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"We confirm adherence to ethical guidelines. The University of Michigan Institutional Review Board determined that this review of medical records (HUM00163494) was exempt from regulation and informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval\/informed consent"}}]}}