Abstract
Ventilator autotriggering (VAT) may induce uncertainty in diagnosing brain death because it may falsely suggest acentral respiratory drive in brain-dead patients where no intrinsic respiratory efforts exist. Since the lack of international standardization of brain death criteria contributes to the loss of potential donor organs, it is important to be aware of this phenomenon, which is anot well-known confounder in the process of diagnosing brain death. The national official recommendations or guidelines for the determination of brain death and organ transplantation of 15 selected European countries (including all 8member states of the Eurotransplant network) were evaluated with respect to VAT. In addition, aliterature search (PubMed, Google Scholar) using the term "ventilator autotriggering", synonyms or similar content-related wording was carried out. The VAT phenomenon was mentioned in 3 of the 15 official recommendations and guidelines on diagnosing brain death. The causes and management of VAT are presented in different ways in the reviewed official recommendations and guidelines. The phenomenon of VAT is inconsistently addressed in the national guidelines and recommendations for the determination of brain death and should, therefore, be included in future harmonized brain death codes. Detection and correction of VAT should be implemented as early as possible by astructured procedure. Additional training and information on this phenomenon should be made available to the entire intensive care unit staff.
Highlights
Ventilator autotriggering (VAT) may induce uncertainty in diagnosing brain death because it may falsely suggest a central respiratory drive in brain-dead patients where no intrinsic respiratory efforts exist
The verification of apnea plays a key role in the clinical declaration of brain death but ventilator autotriggering can mimic an intrinsic respiratory drive where there is none
It is emphasized that this phenomenon is likely to occur more frequently than estimated and it is believed that VAT may remain undetected in an unknown number of cases; this clinical scenario does not seem to be uncommon, as other clinical experiences show [19, 29]
Summary
Ventilator autotriggering (VAT) may induce uncertainty in diagnosing brain death because it may falsely suggest a central respiratory drive in brain-dead patients where no intrinsic respiratory efforts exist. Since the lack of international standardization of brain death criteria contributes to the loss of potential donor organs, it is important to be aware of this phenomenon, which is a not well-known confounder in the process of diagnosing brain death. The national official recommendations or guidelines for the determination of brain death and organ transplantation of 15 selected European countries (including all 8 member states of the Eurotransplant network) were evaluated with respect to VAT. A literature search (PubMed, Google Scholar) using the term “ventilator autotriggering”, synonyms or similar contentrelated wording was carried out
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