RESUMO
INTRODUCTION: The use of continuous positive airway pressure has been shown to improve the tolerance of the apnea test, a critical component of brain death evaluation. The ability to deactivate the apnea backup setting has made apnea testing possible using several conventional mechanical ventilators. Our goal was to evaluate the safety and efficacy of apnea testing performed on mechanical ventilation, compared with the oxygen insufflation technique, for the determination of brain death. METHODS: This was a retrospective study. In 2016, our institution approved a change in policy to permit apnea testing on conventional mechanical ventilation. We examined the records of consecutive adults who underwent apnea testing as part of the brain death evaluation process between 2016 and 2022. Using an apnea test technique was decided at the discretion of the attending physician. Outcomes were successful apnea test and the occurrence of patient instability during the test. This included oxygen desaturation (SpO2) < 90%, hypotension (mean arterial pressure < 65 mm Hg despite titration of vasopressor), cardiac arrhythmia, pneumothorax, and cardiac arrest. RESULTS: Ninety-two adult patients underwent apnea testing during the study period: 58 (63%) with mechanical ventilation, 32 (35%) with oxygen insufflation, and 2 (2%) lacked documentation of technique. Apnea tests could not be completed successfully in 3 of 92 (3%) patients-two patients undergoing the oxygen insufflation technique (one patient with hypoxemia and one patient with hypotension) and one patient on mechanical ventilation (aborted for hemodynamic instability). Hypoxemia occurred in 4 of 32 (12.5%) patients with oxygen insufflation and in zero patients on mechanical ventilation (p = 0.01). Hypotension occurred during 3 of 58 (5%) tests with mechanical ventilation and 4 of 32 (12.5%) tests with oxygen insufflation (p = 0.24). In multivariate analysis, the use of oxygen insufflation was an independent predictor of patient instability during the apnea test (odds ratio 37.74, 95% confidence interval 2.74-520.14). CONCLUSIONS: Apnea testing on conventional mechanical ventilation is feasible and offers several potential advantages over other techniques.
RESUMO
BACKGROUND AND AIMS: Pregnancy is a state of physiological stress to a woman's health. Concomitant complications and infections during pregnancy may necessitate intensive monitoring and management of such patients in critical care settings. This study aims to determine the perceptions about the requirement of obstetric critical care based on the experience of obstetricians. MATERIAL AND METHODS: An observational, questionnaire-based study was conducted in 200 obstetricians working in various settings, who were approached during obstetric conferences. The questionnaire consisted of twenty items and was designed to determine the views of obstetricians, based on their clinical experience, regarding problems at the time of medical or surgical crisis in obstetric patients due to nonavailability of the intensive care services. RESULTS: Seventeen percent of the participating obstetricians had a facility of dedicated obstetric Intensive Care Unit (ICU) at their institution. In the opinion of 62% of the respondents, ICU bed was made available in cases of crisis. Forty-two percent of the obstetricians reported that it took <10 min for the intensivist to reach the critically ill parturient. According to 32% of respondents, the intensivist could not reach within 20 min. There was a delay of more than 30 min in providing critical care services according to almost half (49%) of the respondents. Postpartum hemorrhage (24%) was the leading cause of ICU admission, followed by pregnancy-induced hypertension (14%) and acute respiratory distress syndrome (12%). A majority (87%) of the obstetricians were strongly in favor of a dedicated obstetric ICU. CONCLUSIONS: Need for a dedicated obstetric ICU is felt by most of the obstetricians to improve patient care.
