Articles: apnea-diagnosis.
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The apnea test is used to determine the absence of respiratory drive when determining brain death. Current guidelines for performing the apnea test do not specify the size of insufflation catheter (IC) to use with each endotracheal tube (ETT) size, despite case reports describing procedure-related complications with the use of various IC sizes. We studied the effect of the ratio of IC outer diameter to ETT inner diameter on the pressure and volume generated within the lungs during the apnea test. ⋯ An IC with an outer diameter < 70% of the ETT inner diameter, at 6 L/min, may prevent inappropriate lung pressure and volume during the apnea test. This recommendation, coupled with current American Academy of Neurology guidelines for the determination of brain death, may reduce the risk of procedure-related complications.
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Pediatr Crit Care Me · Feb 2014
Case ReportsDeveloping a Standard Method for Apnea Testing in the Determination of Brain Death for Patients on Venoarterial Extracorporeal Membrane Oxygenation: A Pediatric Case Series.
The revised guidelines for the determination of brain death in infants and children stress that apnea testing is an integral component in determining brain death based on clinical criteria. Unfortunately, these guidelines provide no process for apnea testing during the determination of brain death in patients supported on venoarterial extracorporeal membrane oxygenation. We review three pediatric patients supported on venoarterial extracorporeal membrane oxygenation who underwent apnea testing during their brain death evaluation. This is the only published report to elucidate a reliable, successful method for apnea testing in pediatric patients supported on venoarterial extracorporeal membrane oxygenation. ⋯ Apnea testing on venoarterial extracorporeal membrane oxygenation can be successfully undertaken in the evaluation of brain death. We provide a suggested protocol for apnea testing while on venoarterial extracorporeal membrane oxygenation that is consistent with the updated pediatric brain death guidelines. This is the only published report to elucidate a reliable, successful method for apnea testing in pediatric patients supported on venoarterial extracorporeal membrane oxygenation.
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Pediatric emergency care · Dec 2013
Case ReportsTriage in the tower of babel: interpreter services for children in the prehospital setting.
Minority pediatric populations have higher rates of emergency medical services use than the general pediatric population, and prior studies have documented that limited-English proficiency patients are more likely to undergo invasive procedures, require more resources, and be admitted once they arrive in the emergency department. Furthermore, limited-English proficiency patients may be particularly vulnerable because of immigration or political concerns. ⋯ This infant underwent unnecessary, costly, and harmful interventions because of a lack of interpreter services. In a discussion of the legal, ethical, and medical implications of this case, we conclude that further investigation into prehospital strategies for overcoming language barriers is required to provide optimal prehospital care for pediatric patients.
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Can. J. Gastroenterol. · Oct 2013
Clinical TrialCapnography improves detection of apnea during procedural sedation for percutaneous transhepatic cholangiodrainage.
Capnography provides noninvasive monitoring of ventilation and can enable early recognition of altered respiration patterns and apnea. ⋯ Capnographic monitoring was superior to clinical surveillance in the detection of apnea and in the prediction of oxygen desaturation during procedural sedation for PTCD.