RISK OF HYPOTENSION DURING APNEA TESTING

Objective: To determine the safety of apnea testing. Design: Prospecti ve, consecutive study. Setting: Inner-city trauma center. Patients: A total of 70 apnea tests were performed on 61 comatose patients as part of the determination of brain death. Results: Only 43 examinations (6 1%) were well tolerated. During 27 examinations (39%) patients either developed marked hypotension (greater than or equal to 15% drop in mea n arterial pressure) (n = 23) or required prophylactic vasopressor man ipulation (n = 4). Of the 27 examinations in which hypotension develop ed, 14 were aborted, two were tolerated despite marked hypotension, fo ur were tolerated after administration of prophylactic epinephrine (n = 1) or dopamine hydrochloride (n = 3), and seven were successfully co mpleted after increases in the rate of dopamine infusion during the te st. Conclusions: Hypotension can pose a significant risk to patients u ndergoing apnea testing. Constant monitoring of vital signs throughout the test is essential to its safe completion.