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Intensive Care Medicine

Published in:

01-06-2009 | Original

Carbon dioxide monitoring during long-term noninvasive respiratory support in children

Authors: Rebeca Paiva, Uros Krivec, Guillaume Aubertin, Emmanuelle Cohen, Annick Clément, Brigitte Fauroux

Published in: Intensive Care Medicine | Issue 6/2009

Abstract

Introduction

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.

Materials and methods

Pulse oximetry and carbon dioxide pressure measured by capillary arterialized blood gases and a combined transcutaneous carbon dioxide and pulse oximetry (PtcCO₂/SpO₂) 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 PtcCO₂/SpO₂ monitor were performed in 50 other patients receiving nocturnal noninvasive respiratory support at home.

Results

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 PtcCO₂/SpO₂ monitor. Twenty-one of the 50 patients (42%) on long-term noninvasive respiratory support presented nocturnal hypercapnia, defined by a PtcCO₂ value >50 mmHg, without nocturnal hypoxemia. Daytime capillary arterialized carbon dioxide levels were normal in 18 of these 21 patients.

Conclusions

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.

Simonds A, Muntoni F, Heather S, Fielding S (1998) Impact of nasal ventilation on survival in hypercapnic Duchenne muscular dystrophy. Thorax 53:949–952PubMedCrossRef

Mellies U, Ragette R, Dohna Schwake C, Boehm H, Voit T, Teschler H (2003) Long-term noninvasive ventilation in children and adolescents with neuromuscular disorders. Eur Respir J 22:631–636PubMedCrossRef

Fauroux B, Pigeot J, Polkey MI, Roger G, Boulé M, Clément A, Lofaso F (2001) Chronic stridor caused by laryngomalacia in children. Work of breathing and effects of noninvasive ventilatory assistance. Am J Respir Crit Care Med 164:1874–1878PubMed

(1998) Management of pediatric patients requiring long-term ventilation. Chest 113:322S–336S

Berkenbosch JW, Lam J, Burd RS, Tobias JD (2001) Noninvasive monitoring of carbon dioxide during mechanical ventilation in older children: end-tidal versus transcutaneous techniques. Anesth Analg 92:1427–1431PubMedCrossRef

Cuvelier A, Grigoriu B, Molano LC, Muir JF (2005) Limitations of transcutaneous carbon dioxide measurements for assessing long-term mechanical ventilation. Chest 127:1744–1748PubMedCrossRef

Bolliger D, Steiner LA, Kasper J, Aziz OA, Filipovic M, Seeberger MD (2007) The accuracy of non-invasive carbon dioxide monitoring: a clinical evaluation of two transcutaneous systems. Anaesthesia 62:394–399PubMedCrossRef

Domingo C, Canturri E, Luján M, Moreno A, Espuelas H, Marín A (2006) Transcutaneous measurement of partial pressure of carbon dioxide and oxygen saturation: validation of the SenTec monitor. Arch Bronconeumol 42:246–251PubMed

Feiner JR, Severinghaus JW, Bickler PE (2007) Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender. Anesth Analg 105(6 Suppl):S18–S23PubMedCrossRef

10.

Gaultier C, Boulé M, Allaire Y, Clément A, Burry A, Girard F (1978) Determination of capillary oxygen tension in infants and children: assessment of methodology and normal values during growth. Bull Eur Physiopath Resp 14:287–294

11.

Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMed

12.

Quanjer PH (1993) Standardized lung function testing. Eur Resp J 6(Suppl. 16):5s–30s

13.

Fauroux B, Lavis JF, Nicot F, Picard A, Boelle PY, Clement A, Vazquez MP (2005) Facial side effects during noninvasive positive pressure ventilation in children. Intens Care Med 31:965–969CrossRef

14.

Gonzalez J, Sharshar T, Hart N, Chadda K, Raphael JC, Lofaso F (2003) Air leaks during mechanical ventilation as a cause of persistent hypercapnia in neuromuscular disorders. Intens Care Med 29:596–602

15.

Wallgren-Pettersson C, Bushby K, Mellies U, Simonds A (2004) 117th ENMC workshop: ventilatory support in congenital neuromuscular disorders—congenital myopathies, congenital muscular dystrophies, congenital myotonic dystrophy and SMA (II). Neuromuscular Disord 14:56–69CrossRef

16.

Ward S, Chatwin M, Heather S, Simonds AK (2005) Randomised controlled trial of non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax 60:1019–1024PubMedCrossRef

17.

Toussaint M, Chatwin M, Soudon P (2007) Mechanical ventilation in Duchenne patients with chronic respiratory insufficiency: clinical implications of 20 years published experience. Chron Respir Dis 4:167–177PubMedCrossRef

18.

Milross MA, Piper AJ, Norman M, Willson GN, Grunstein RR, Sullivan CF, Bye PT (2001) Predicting sleep-disordered breathing in patients with cystic fibrosis. Chest 120:1239–1245PubMedCrossRef

Title: Carbon dioxide monitoring during long-term noninvasive respiratory support in children
Authors: Rebeca Paiva
Uros Krivec
Guillaume Aubertin
Emmanuelle Cohen
Annick Clément
Brigitte Fauroux
Publication date: 01-06-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 6/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1408-5

At a glance: The STEP trials

Springer Medicine

Carbon dioxide monitoring during long-term noninvasive respiratory support in children

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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