Increased apnea threshold in a pediatric patient with suspected brain death.

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.