The purpose of this report is to provide an overview of apnea testing and discuss issues related to the administration and safety of the procedure. While apnea testing is not new, it still lacks consensus standardization regarding the actual procedure, monitored parameters, and evidence-based safety measures that may be used to prevent complications.

A “positive” test is defined by a total absence of respiratory efforts under these conditions. This procedure requires close monitoring of a patient as all ventilator support is temporarily removed and Pa co 2 levels are allowed to rise. As a consequence, apnea testing is an important component of brain death assessment. The drive to breathe in the setting of an intense ventilatory stimulus (ie, respiratory acidosis) is a critical marker of brainstem function. These findings are coupled with a series of confirmatory tests, and the diagnosis of brain death is established based on consensus recommendations. The key findings in brain death are unresponsiveness, and absence of brainstem reflexes in the setting of a devastating neurological injury. Strong knowledge of neurophysiology and an understanding of brain death etiology must be used to confidently determine brain death.

The diagnosis of brain death is a complex process.

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