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Brain death is suspected when a patient with a destructive neurologic brain injury on a ventilator fails to generate respirations and other brainstem reflexes are absent. An apnea test is mandated in brain-death evaluation. Apnea is concluded when no breathing effort is observed at PaCO2 of 60 mm Hg or with a 20 mm Hg increase from normal baseline.1 There are no reported cases of adult patients who were declared brain dead and later initiated respirations. Two cases from the U.K. (brain death and cardiac death) have been described where the ventilator readings were erroneous but remotely suggested patient effort.2,3 We have recently come across several instances during brain-death determination when it appeared that patients falsely triggered the ventilator. We would like to call attention to this phenomenon of ventilator self-cycling.
Methods.
From January 2002 to February 2005, we performed apnea tests in 83 patients in our neurologic-neurosurgical intensive care unit for brain-death determination. All patients fulfilled …
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