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DISCONNECTING TESTS AND OXYGEN UPTAKE IN THE DIAGNOSIS OF TOTAL BRAIN DEATH
Author(s) -
Milhaud A.,
Riboulot M.,
Gayet H.
Publication year - 1978
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.1978.tb50342.x
Subject(s) - anesthesia , hypercapnia , ventilation (architecture) , apnea , oxygen , blood pressure , hypoxia (environmental) , arterial blood , medicine , hypothermia , chemistry , acidosis , mechanical engineering , organic chemistry , engineering
S ummary The disconnecting test in pure oxygen using the apnea technique of Hirsch and Volhard (1905) and Holmdahl (1956) has been described in Amiens (1972). This test produces transient hypercapnia without hypoxia and may be prolonged for more than 20 minutes without danger of either circulatory arrest or additional cerebral damage. Preliminary artificial ventilation in pure oxygen has to be given for more than one hour (denitrogenation). O 2 uptake is measured using the ventilation spirograph. Arterial blood is taken every three minutes for gas measurements. The ventricular frequency and arterial pressure are monitored at the same time. In ten adults of average size, all with total brain death, we found a mean oxygen uptake of 193 ml/ minute. Ventricular frequency and arterial blood pressure P a O 2 was always higher than 100 mm Hg (even after 20 minutes). P a CO 2 increased dramatically to more than 80 mm Hg, and the blood pH decreased to less than 7.05 units, but spontaneous ventilation was never present again. The fact that spontaneous ventilation is not present postdenitrogenation and after apnea in pure oxygen for more than 15 minutes seems to be one of the best criteria of total brain death, except in cases of acute intoxication or deep hypothermia.