Sołek-Pastuszka Joanna, Saucha Wojciech, Iwańczuk Waldemar, Bohatyrewicz Romuald
Department of Anesthesiology and Intensive Care Medicine, Pomeranian Medical University Szczecin, Poland.
Anaesthesiol Intensive Ther. 2015;47(4):363-7. doi: 10.5603/AIT.2015.0050.
The concept of brain death (BD) was initially described in 1959 and subsequently became widely accepted in the majority of countries. Nevertheless, the diagnostic guidelines for BD markedly differ, especially regarding the apnoea test (AT), a crucial element of clinical BD confirmation. The current basic guidelines recommend preoxygenation rather than disconnection from the ventilator and insertion of an oxygen insufflation catheter into the endotracheal tube. Although a properly prepared and conducted AT is relatively safe, it has to be aborted in cases of serious disturbances, such as severe cardiac arrhythmia, cardiac arrest, hypotension, hypercarbia, desaturation and tension pneumothorax. These complications may be more frequent in patients with previously existing risk factors, such as poor oxygenation, severe acidosis, hypotension and cardiac rhythm disturbances. Airway injuries can occur if the insufflation catheter is placed too deep or catheter-related obstruction of the intubation tube occurs. It is widely accepted that AT should be performed as the very last BD diagnostic procedure due to its possible lethal consequences. Reports concerning the possible pitfalls of AT and confounding situations have inspired attempts to determine the most effective and safe method of AT. The use of CPAP with oxygen supplementation is becoming highly popular. CPAP can be generated in three manners: directly by the ventilator; through the use of a CPAP valve with a reservoir; and through the use of a highly traditional T-piece system with a reservoir bag connected to distal tubing immersed in water.
脑死亡（BD）的概念最初于1959年被描述，随后在大多数国家被广泛接受。然而，BD的诊断指南存在显著差异，尤其是在用于临床BD确认的关键要素—— apnea试验（AT）方面。当前的基本指南推荐进行预充氧，而不是断开呼吸机并将充氧导管插入气管导管。尽管准备充分且实施得当的AT相对安全，但在出现严重干扰情况时，如严重心律失常、心脏骤停、低血压、高碳酸血症、血氧饱和度下降和张力性气胸，必须中止该试验。在有既往危险因素的患者中，如氧合不良、严重酸中毒、低血压和心律失常，这些并发症可能更常见。如果充氧导管放置过深或出现与导管相关的插管堵塞，可能会发生气道损伤。由于AT可能产生致命后果，人们普遍认为应将其作为BD诊断的最后一项程序。关于AT可能存在的陷阱和混淆情况的报告促使人们尝试确定最有效和安全的AT方法。使用持续气道正压通气（CPAP）并补充氧气正变得非常流行。CPAP可以通过三种方式产生：直接由呼吸机产生；通过使用带有储气囊的CPAP阀产生；以及通过使用高度传统的带有储气囊的T形管系统产生，该储气囊连接到浸入水中的远端管道。
