Barrier Damien, Vanacker Ludivine, Muller Grégoire, Szychowiak Piotr, Bretagnol Anne, Levebvre Isabelle, Narcisse Éric, Pascot Léa, Boulain Thierry, Nay Mai-Anh
Coordination Hospitalière des Prélèvements d'Organes et de Tissus, Centre Hospitalier Universitaire d'Orléans, Orléans, France.
Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Orléans, Orléans, France.
Crit Care Med. 2025 Jul 1;53(7):e1449-e1456. doi: 10.1097/CCM.0000000000006717. Epub 2025 May 19.
This study aimed to assess the feasibility and safety of use of high-flow oxygen (HFO) through the endotracheal tube for apnea testing during brain death evaluation.
Prospective, interventional, single-center study.
ICUs at the Orléans University Hospital, France.
All adult patients meeting the criteria for clinical brain death and requiring an apnea test were eligible.
Fifteen patients underwent two successive apnea tests in the same order, each lasting 10 minutes: The first apnea test used 8 L/min of oxygen via a T-piece without a positive end-expiratory pressure valve connected to the endotracheal tube (standard test). The second apnea test used HFO at 50 L/min and F io 2 of 1.0 through a specialized device connected to the endotracheal tube. Arterial blood gases were measured every 2 minutes during both apnea tests. The primary objective was to investigate the feasibility and safety of use of HFO through the endotracheal tube for apnea testing compared with use of a T-piece in patients whose clinical examination was consistent with brain death and required an apnea test.
All patients reached Pa co 2 greater than 60 mm Hg by the end of both apnea tests. At 10 minutes, Pa co 2 was 69.1 ± 5.9 mm Hg with the T-piece and 71.3 ± 6.0 mm Hg with HFO. Pa o 2 decreased significantly during the T-piece apnea test (from 404 ± 115 to 215 ± 118 mm Hg) but remained stable with HFO apnea test (from 342 ± 114 to 308 ± 92 mm Hg).
HFO through the endotracheal tube is feasible and safe method for apnea testing. In patients with confirmed brain death via the standard apnea test, HFO yielded consistent diagnostic results while maintaining better oxygenation. Further research, particularly randomized trials, is needed to confirm the benefits of HFO in apnea testing.
本研究旨在评估在脑死亡评估期间通过气管内导管使用高流量氧气（HFO）进行呼吸暂停试验的可行性和安全性。
前瞻性、干预性、单中心研究。
法国奥尔良大学医院重症监护病房。
所有符合临床脑死亡标准且需要进行呼吸暂停试验的成年患者均符合条件。
15例患者按相同顺序进行了两次连续的呼吸暂停试验，每次持续10分钟：第一次呼吸暂停试验通过连接到气管内导管的不带呼气末正压阀的T形管以8升/分钟的流量输送氧气（标准试验）。第二次呼吸暂停试验通过连接到气管内导管的专用设备以50升/分钟的流量和1.0的吸入氧分数使用HFO。在两次呼吸暂停试验期间，每2分钟测量一次动脉血气。主要目的是研究在临床检查符合脑死亡且需要进行呼吸暂停试验的患者中，与使用T形管相比，通过气管内导管使用HFO进行呼吸暂停试验的可行性和安全性。
在两次呼吸暂停试验结束时，所有患者的动脉血二氧化碳分压（Pa co 2）均高于60毫米汞柱。10分钟时，使用T形管时Pa co 2为69.1±5.9毫米汞柱，使用HFO时为71.3±6.0毫米汞柱。在T形管呼吸暂停试验期间，动脉血氧分压（Pa o 2）显著下降（从404±115降至215±118毫米汞柱），但在HFO呼吸暂停试验期间保持稳定（从342±114降至308±92毫米汞柱）。
通过气管内导管使用HFO进行呼吸暂停试验是一种可行且安全的方法。在通过标准呼吸暂停试验确诊脑死亡的患者中，HFO产生了一致的诊断结果，同时保持了更好的氧合。需要进一步的研究，特别是随机试验，以证实HFO在呼吸暂停试验中的益处。
