Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
Abstract
Apnea testing (AT) is a critical component of the neurological determination of death. Although complications during AT are well documented, bilateral pneumothorax is an exceptionally rare and potentially life‐threatening event. This case report highlights a rare occurrence of bilateral pneumothorax during AT, explores its clinical implications and underscores the need for refining procedural guidelines. We report the case of a 38‐year‐old female admitted with a brainstem bleed due to accelerated hypertension. Apnea testing was initiated to confirm brain death after meeting all prerequisites. During the test, high‐flow oxygen insufflation was administered using a wide‐bore catheter, partially occluding the endotracheal tube (ETT). Within minutes, the patient developed left‐sided facial swelling, subcutaneous emphysema and hemodynamic instability, indicating tension pneumothorax. Immediate chest decompression with intercostal drains (ICDs) confirmed bilateral pneumothorax. Spontaneous respiratory efforts observed during the test, along with arterial blood gas analysis revealing a significant CO2 rise, indicating residual brainstem activity. Hence the patient was not brain dead and subsequent management continued. His lungs were fully expanded within 24 hours. This case demonstrates the importance of prompt recognition and management of complications during AT. Bilateral pneumothorax, though rare, poses a significant risk to patient stability and can dramatically affect organ donation opportunities. This report highlights the need for heightened vigilance during AT, especially in managing oxygen delivery to prevent barotrauma. It calls for more detailed and standardized guidelines to reduce the risk of such rare complications, ensuring patient safety and optimizing organ donation outcomes.
How to cite this article:
Jyoti Goyal, Rahul Kumar, Manu Gupta, Tushar Vashisht, Bhawesh Thakur and Alok Ahlawat. Bilateral Pneumothorax with Subcutaneous Emphysema During Apnea Testing: A Case Report.
DOI: https://doi.org/10.36478/10.36478/makrjms.2024.12.573.576
URL: https://www.makhillpublications.co/view-article/1815-9346/10.36478/makrjms.2024.12.573.576