Routine monitoring of noninvasive respiratory support relies on nocturnal pulse oximetry and daytime arterial blood gases, without systematic nocturnal carbon dioxide recording. The aim of the study was to assess if overnight pulse oximetry and daytime blood gases are sufficiently accurate to detect nocturnal hypoventilation in children receiving long-term noninvasive respiratory support.
Pulse oximetry and carbon dioxide pressure measured by capillary arterialized blood gases and a combined transcutaneous carbon dioxide and pulse oximetry (PtcCO(2)/SpO(2)) monitor were compared in 65 patients (asthma, n = 16, recurrent bronchitis, n = 8, lung infection, n = 8, cystic fibrosis, n = 15, interstitial lung disease, n = 6, neuromuscular disease, n = 12). Daytime capillary arterialized blood gases and nocturnal recording of pulse oximetry and carbon dioxide by means of a combined PtcCO(2)/SpO(2) monitor were performed in 50 other patients receiving nocturnal noninvasive respiratory support at home.
A correlation was observed between pulse oximetry (r = 0.832, P < 0.0001) and carbon dioxide pressure (r = 0.644, P < 0.0001) measured by capillary arterialized blood gases and the combined PtcCO(2)/SpO(2) monitor. Twenty-one of the 50 patients (42%) on long-term noninvasive respiratory support presented nocturnal hypercapnia, defined by a PtcCO(2) value >50 mmHg, without nocturnal hypoxemia. Daytime capillary arterialized carbon dioxide levels were normal in 18 of these 21 patients.
Nocturnal hypercapnia may occur in children receiving nocturnal noninvasive respiratory support at home. Nocturnal pulse oximetry and daytime arterial blood gases are not sufficiently accurate to diagnose nocturnal hypercapnia, underlying the importance of a systematic carbon dioxide monitoring in children receiving noninvasive respiratory support.
"Upper airway surgery was performed in case of clinical upper airway obstruction (such as hypertrophy of the adenoids, tonsils, and/or turbinates evaluated by the ENT specialist) associated with an abnormal sleep study. NPPV by means of continuous positive airway pressure (CPAP) in infants or bilevel positive airway pressure ventilation in older patients was proposed in case of nocturnal alveolar hypoventilation, defined by a minimal SpO 2 < 90% for !10% of sleep time and/or a maximal PtcCO 2 > 50 mmHg for !10% of sleep time [Paiva et al., 2009], and/or an AI ! 10 events/hr without any surgically accessible airway obstruction. "
[Show abstract][Hide abstract] ABSTRACT: Children with achondroplasia are at risk of sleep-disordered breathing. The aim of the study was to evaluate lung function and sleep-disordered breathing in children with achondroplasia. An interview, clinical examination, lung function tests with blood gases, and a polygraphic sleep study were obtained as part of routine annual evaluation in consecutive children with achondroplasia. We included 30 children (median age 3.0 years, range: 0.4-17.1) over a period of 21 months. Habitual snoring and witnessed apneas were observed in 77% and 33% of the patients, respectively. Prior to the sleep study, 10/29 (34%) patients had undergone upper airway surgery and 5/29 (17%) craniocervical decompression operation. Arterial blood gases were abnormal in two (7%) patients. Sleep findings were abnormal in 28/30 (93%) patients. Eleven (37%) patients had an apnea index≥1 event/hr and 26 (87%) had an apnea-hypopnea index≥5 events/hr. The ≥3% desaturation index was >5/hr in 22 (73%) patients. Sixteen (53%) patients had a minimal pulse oximetry<90% but only two (7%) patients had a maximal transcutaneous carbon dioxide pressure>50 mmHg during sleep. As a consequence, the following therapeutic interventions were performed: upper airway surgery in four patients and noninvasive positive pressure ventilation (NPPV) in five other patients, resulting in an improvement in sleep studies in all nine patients. Systematic sleep studies are recommended in children with achondroplasia because of the high prevalence of sleep-disordered breathing. Upper airway surgery and NPPV are effective treatments of sleep-disordered breathing.
American Journal of Medical Genetics Part A 08/2012; 158A(8):1987-93. DOI:10.1002/ajmg.a.35441 · 2.16 Impact Factor
"Overnight pulse oximetry (SpO2) and transcutaneous carbon dioxide (PtcCO2) recordings were performed in room air (SenTec Digital Monitor, SenTec AG, Therwil, Switzerland). We recorded the mean and minimal SpO2, number of desaturations ≥ 4%/h of recording, percentage of time spent at specific SpO2values, mean and maximum PtcCO2 and percentage of time spent at specific PtcCO2 values. "
[Show abstract][Hide abstract] ABSTRACT: Pulmonary hypertension (PH) may affect survival in cystic fibrosis (CF) and can be assessed on echocardiographic measurement of the pulmonary acceleration time (PAT). The study aimed at evaluating PAT as a tool to optimize timing of lung transplant in CF patients. Prospective multicenter longitudinal study of patients with forced expiratory volume in 1 second (FEV1) ≤60% predicted. Echocardiography, spirometry and nocturnal oximetry were obtained as part of the routine evaluation. We included 67 patients (mean FEV1 42±12% predicted), among whom 8 underwent lung transplantation during the mean follow-up of 19±6 months. No patients died. PAT was determined in all patients and correlated negatively with systolic pulmonary artery pressure (sPAP, r=-0.36, P=0.01). Patients in the lowest PAT tertile (<101 ms) had lower FEV1 and worse nocturnal oxygen saturation, and they were more often on the lung transplant waiting list compared to patients in the other tertiles. Kaplan-Meier curves showed a shorter time to lung transplantation in the lowest PAT tertile (P<0.001) but not in patients with sPAP>35 mmHg. By multivariate analysis, FEV(1)and nocturnal desaturation were the main determinants of reduced PAT. A PAT<101 ms reduction is a promising tool for timing of lung transplantation in CF.
[Show abstract][Hide abstract] ABSTRACT: La ventilation non invasive (VNI) au long cours est une technique d’assistance respiratoire en plein essor chez l’enfant. Elle consiste en la délivrance d’une assistance respiratoire à travers une interface qui respecte les voies aériennes du patient, comme un masque nasal ou facial, plus rarement des canules nasales. La VNI est indiquée dans les hypoventilations alvéolaires, dont les causes sont variées. En effet, l’hypoventilation peut être liée à une maladie neuromusculaire, à une anomalie maxillofaciale ou des voies aériennes supérieures, à une déformation de la cage thoracique, à une maladie pulmonaire ou à une anomalie du contrôle de la respiration. Dans ces pathologies chroniques, la VNI est le traitement de choix de l’insuffisance respiratoire, car c’est une technique non invasive qui peut être utilisée à la demande, préférentiellement pendant le sommeil. L’essor de la VNI s’explique à la fois par un meilleur dépistage des troubles respiratoires du sommeil dans ces maladies et la mise sur le marché d’interfaces et de ventilateurs mieux adaptés à l’enfant.
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