Objective: To evaluate the current standards for apnea testing in the evaluation of brain death in children.
Design: Case report.
Setting: A tertiary pediatric intensive care unit (ICU).
Patients: A single patient admitted to the ICU.
Interventions: None.
Measurements and main 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).
Conclusion: This case report suggests that current guidelines for apnea testing may lead to erroneous evaluation of medullary-respiratory drive.