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Respiratory Research
Published in: Respiratory Research 1/2020

01-12-2020 | Polysomnography | Research

Monitoring of noninvasive ventilation: comparative analysis of different strategies

Authors: Marjolaine Georges, Claudio Rabec, Elise Monin, Serge Aho, Guillaume Beltramo, Jean-Paul Janssens, Philippe Bonniaud

Published in: Respiratory Research | Issue 1/2020

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Abstract

Background

Noninvasive ventilation (NIV) represents an effective treatment for chronic respiratory failure. However, empirically determined NIV settings may not achieve optimal ventilatory support. Therefore, the efficacy of NIV should be systematically monitored. The minimal recommended monitoring strategy includes clinical assessment, arterial blood gases (ABG) and nocturnal transcutaneous pulsed oxygen saturation (SpO2). Polysomnography is a theoretical gold standard but is not routinely available in many centers. Simple tools such as transcutaneous capnography (TcPCO2) or ventilator built-in software provide reliable informations but their role in NIV monitoring has yet to be defined. The aim of our work was to compare the accuracy of different combinations of tests to assess NIV efficacy.

Methods

This retrospective comparative study evaluated the efficacy of NIV in consecutive patients through four strategies (A, B, C and D) using four different tools in various combinations. These tools included morning ABG, nocturnal SpO2, TcPCO2 and data provided by built-in software via a dedicated module. Strategy A (ABG + nocturnal SpO2), B (nocturnal SpO2 + TcPCO2) and C (TcPCO2 + builtin software) were compared to strategy D, which combined all four tools (NIV was appropriate if all four tools were normal).

Results

NIV was appropriate in only 29 of the 100 included patients. Strategy A considered 53 patients as appropriately ventilated. Strategy B considered 48 patients as appropriately ventilated. Strategy C misclassified only 6 patients with daytime hypercapnia.

Conclusion

Monitoring ABG and nocturnal SpO2 is not enough to assess NIV efficacy. Combining data from ventilator built-in software and TcPCO2 seems to represent the best strategy to detect poor NIV efficacy.
Trial registration Institutional Review Board of the Société de Pneumologie de Langue Française (CEPRO 2016 Georges)
Appendix
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Metadata
Title
Monitoring of noninvasive ventilation: comparative analysis of different strategies
Authors
Marjolaine Georges
Claudio Rabec
Elise Monin
Serge Aho
Guillaume Beltramo
Jean-Paul Janssens
Philippe Bonniaud
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2020
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/s12931-020-01586-8

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