To the Editor.
—I read with great interest the article "Apneic Oxygenation in Apnea Tests for Brain Death: A Controlled Trial." in the October issue of the Archives1 The "Patients and Methods" section mentions that "all patients were deeply comatose with absent brain-stem reflexes and no spontaneous respirations." If all of these patients had already been declared legally brain dead (including proper apneic oxygenation), then it should have been explicitly stated. If that were not the case, how was it ethically (or legally) permissible to disconnect respirators from patients who were not legally brain dead? It is not at all suprising that in that group significant hypoxia developed and one patient had cardiac arrest!New York State health regulations require that families be notified when brain death is being confirmed. Was this study performed with familial consent? A simply explanatory sentence in this otherwise very interesting article could avoid
Keilson MJ. Apneic Oxygenation in Apnea Tests. Arch Neurol. 1991;48(8):789. doi:10.1001/archneur.1991.00530200025009
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