Respiratory management in acute CNS catastrophies

To the Editor: In their thorough review of respiratory problems in the neurologically critically ill, Wijdicks and Borel1 conclude with the topic of apnea testing in brain death and clearly spell out many of the issues. However, they also make a statement that potentially compromises the process of caring for the terminally ill. In detailing the downsides of apnea testing, they note that “the procedure may induce hypotension and hypoxemia, which may make organs unsuitable for transplantation … .”1 It is important to note that the patient in question is not dead yet, and such preparation for organ harvest, no matter how discrete or professional, subconsciously permeates discussions in the final hours. It is easily misinterpreted by family members as contrary to the …