Acute and Critical Care

Original Article

Neurology
Predisposing Hemodynamic Factors Associated with a Failed Apnea Test during Brain Death Determination: Eun Young Kim, Ji Hyun Kim; Korean J Crit Care Med. 2016;31(3):236-242. Published online August 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00332

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Background
The apnea test is an essential component in the clinical determination of brain death, however it may incur a significant risk of complications such as hypotension, hypoxia and even cardiac arrest. We analyzed the risk factors associated with a failed apnea test during brain death assessment in order to predict and avoid these adverse events.
Methods
Medical records on apnea tests performed for brain-dead donors at our institution between January 2009 and January 2016 were retrospectively reviewed. Age, gender, etiology of brain death, use of catecholamines and results of arterial blood gas analysis (ABGA), systolic/diastolic blood pressure (SBP/DBP), mean arterial pressure and central venous pressure prior to apnea test initiation were collected as variables. A-a gradient and P_aO2/F_iO2 were calculated for more precise assessment of the respiratory system. In total, 267 cases were divided into two groups based on those who completed the apnea test and those who failed the test.
Results
13 cases failed the apnea test. Among them, seven cases failed due to severe hypotension (SBP < 60 mmHg) and the others failed due to refractory hypoxia. In terms of hemodynamic state, SBP was significantly higher in the completed test group than the failed group (126.5 ± 23.9 vs. 103 ± 15.2, respectively; p = 0.001). In ABGA, the completed test group showed significantly higher P_aO2/ F_iO2 (313.6 ± 229.8 vs. 141.5 ± 131.0, respectively; p = 0.008) and a lower A-a gradient (278.2 ± 209.5 vs. 506.2 ± 173.1, respectively; p = 0.000). In multivariable analysis, low SBP (p = 0.003) and high A-a gradient (p = 0.044) were independent risk factors associated with a failed apnea test.
Conclusions
Although the unexpected adverse events during the apnea test for brain death determination do not occur frequently, they can be fatal. If a brain-dead patient has low SBP and a high A-a gradient, clinicians should pay more attention and prepare for potential complications prior to the apnea test.

Citations

Citations to this article as recorded by

Identification of Hemodynamic Risk Factors for Apnea Test Failure During Brain Death Determination
Jin Joo Kim, Eun Young Kim
Transplantation Proceedings.2019; 51(6): 1655. CrossRef
Reduction of Apnea Test Time in an Extracorporeal Membrane Oxygenation-Dependent Potential Donor
Hyeon Sook Jee, Sora Cha, Gaab Soo Kim
Korean Journal of Transplantation.2017; 31(1): 49. CrossRef

Review

Pharmacology
Assessment and Treatment of Pain in Adult Intensive Care Unit Patients: Jun Mo Park, Ji Hyun Kim; Korean J Crit Care Med. 2014;29(3):147-159. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.147

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693 Download
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Abstract PDF

In most cases, patients admitted to an intensive care unit (ICU) have suffered from severe trauma, undergone major surgery or been treated for a serious medical illness. Although they often experience more intense pain than general ward patients, they are frequently unable to communicate their experiences to health care providers, thus preventing accurate assessment and treatment of their pain. If appropriate measures are not taken to treat pain in critically ill patients, stress response or sympathetic overstimulation can lead to complications. The short-term consequences of untreated pain include higher energy expenditure and immunomodulation. Longer-term, untreated pain increases the risk of post-traumatic stress disorder. Because pain is quite subjective, the accurate assessment of pain is very difficult in the patients with impaired communication ability. The current most valid and reliable behavioral pain scales used to assess pain in adult ICU patients are the Behavioral Pain Scale and the Critical-Care Pain Observation Tool. Once pain has been accurately assessed using these methods, various pharmacologic and non-pharmacologic therapies should be performed by the multidisciplinary care team. Accurate assessment and proper treatment of pain in adult ICU patients will improve patients outcome, which reduces the stress response and decreases the risk of post-traumatic stress disorder.

Citations

Citations to this article as recorded by

Nurses’ knowledge, practice, and associated factors of pain assessment in critically ill adult patients at public hospitals, Addis Ababa, Ethiopia
Temesgen Ayenew, Berhanu Melaku, Mihretie Gedfew, Haile Amha, Keralem Anteneh Bishaw
International Journal of Africa Nursing Sciences.2021; 15: 100361. CrossRef
Impact of Pain Management Algorithm on Pain Intensity of Patients with Loss of Consciousness Hospitalized in Intensive Care Unit: A Clinical Trial
Zahra Dehghani, Asadollah Keikhaei, Fariba Yaghoubinia, Aliakbar Keykha, Masoom Khoshfetrat
Medical - Surgical Nursing Journal.2019;[Epub] CrossRef
Ignorance may be Bliss (for Intensivists), but not for ICU Patients!
Atul P. Kulkarni, Sumitra G Bakshi
Indian Journal of Critical Care Medicine.2019; 23(4): 161. CrossRef

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