Carbon dioxide monitoring during long-term noninvasive respiratory support in children
ABSTRACT 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.
- SourceAvailable from: Sébastien Julliand[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 · 2.05 Impact Factor
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ABSTRACT: Our objective was to assess within a feasibility study the correlation and agreement of transcutaneous carbon dioxide (PtcCO2) monitoring with venous carbon dioxide (PvCO2) in infants with bronchiolitis in the emergency room (ER) and pediatric department. Sixty infants (aged 3.6 ± 3.3 months) admitted to our ER with bronchiolitis were included. PtcCO2 measurements (SenTec Digital Monitoring System) collected prospectively were compared with simultaneous PvCO2 drawn for patient care. Analysis included 100 measurements. The correlation of PtcCO2 and PvCO2 (r = 0.71, p < 0.001) was good, and the agreement (mean difference ± standard deviation of the differences 1.9 ± 7.0 mmHg) was adequate; average PtcCO2 was slightly lower than PvCO2. Changes in PtcCO2 and PvCO2 for consecutive measurements within each patient correlated (r = 0.41, p < 0.01). The level of PtcCO2 correlated with disease severity clinical score (p < 0.001). Conclusions: PtcCO2 monitoring was feasible in the ER and pediatric department and was found to have a good correlation and adequate agreement with PvCO2 in infants with bronchiolitis. Because the standard deviation of the differences was relatively high, though comparable to the literature, we suggest that PtcCO2 should not replace blood gas but rather serve as a complementary tool for trending and for real-time continuous assessment of the CO2 levels.European Journal of Pediatrics 08/2014; 174(3). DOI:10.1007/s00431-014-2407-2 · 1.98 Impact Factor
Article: Spécificités de la VNI chez l’enfant[Show abstract] [Hide abstract]
ABSTRACT: The indications of NIV in children are daytime hypercapnia, a history of a severe respiratory exacerbation and nocturnal hypoventilation. Clinical signs of the latter may lack in children, underlying the need for systematic sleep studies with recording of nocturnal gas exchange in children with neuromuscular disease. Monitoring may alternate home and hospital recordings. NIV interfaces may cause facial deformities. Cough assisted techniques must be associated to NIV in children with neuromuscular disease. Finally, the management of these children must be performed in specialized multidisciplinary centers.Revue des Maladies Respiratoires Actualites 07/2012; 4(3):130–133. DOI:10.1016/S1877-1203(12)70208-2