Sleep Transcutaneous vs. End-Tidal CO2 Monitoring for Patients with Neuromuscular Disease

Won, Yu Hui; Choi, Won Ah; Lee, Jang Woo; Bach, John R.; Park, Jinyoung; Kang, Seong-Woong

doi:10.1097/phm.0000000000000345

Cited by 20 publications

(12 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With the availability of oximetry, and capnography to measure end-tidal CO 2 , arterial blood gas sampling is rarely if ever needed for people with NMD [ 20 ]. In addition to the discomfort, 25% of patients hyperventilate as a result of the anxiety and pain caused by the arterial puncture [ 21 ].…”

Section: Patient Evaluation Specific For Ventilatory Pump Failurementioning

confidence: 99%

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Bach

2017

Ann Rehabil Med

View full text Add to dashboard Cite

This review article describes definitive noninvasive respiratory management of respiratory muscle dysfunction to eliminate need to resort to tracheotomy. In 2010 clinicians from 22 centers in 18 countries reported 1,623 spinal muscular atrophy type 1 (SMA1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis users of noninvasive ventilatory support (NVS) of whom 760 required it continuously (CNVS). The CNVS sustained their lives by over 3,000 patient-years without resort to indwelling tracheostomy tubes. These centers have now extubated at least 74 consecutive ventilator unweanable patients with DMD, over 95% of CNVS-dependent patients with SMA1, and hundreds of others with advanced neuromuscular disorders (NMDs) without resort to tracheotomy. Two centers reported a 99% success rate at extubating 258 ventilator unweanable patients without resort to tracheotomy. Patients with myopathic or lower motor neuron disorders can be managed noninvasively by up to CNVS, indefinitely, despite having little or no measurable vital capacity, with the use of physical medicine respiratory muscle aids. Ventilator-dependent patients can be decannulated of their tracheostomy tubes.

show abstract

Section: Patient Evaluation Specific For Ventilatory Pump Failurementioning

confidence: 99%

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Bach

2017

Ann Rehabil Med

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Arterial blood gas analysis is the gold standard test for assessing PaCO 2 levels. However, it is not regarded as an appropriate screening test considering its painful and invasive nature, as well as the need for continuous catheterization 17 . Various techniques for noninvasive CO 2 level monitoring have been tested in different patient populations for diagnostic efficacy since their introduction into clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Nocturnal Hypoventilation by Different Methods and Definitions in Children with Neuromuscular Disease: Oxycapnography and Blood Gas Analysis

Ayhan¹,

Karatoprak²,

Onay³

et al. 2021

MMJ

View full text Add to dashboard Cite

Objective: To investigate whether partial arterial carbon dioxide pressure (PaCO2) level in arterial blood gas analysis that was used to predict nocturnal hypoventilation (NH) is concordant with nocturnal end-tidal CO2 (PetCO2) measurement obtained by a noninvasive method of oxycapnography in children with neuromuscular disease (NMD). Methods: Twenty-one patients aged 6-18 years with a confirmed diagnosis of NMD were enrolled. Each patient underwent a nocturnal oxycapnography study using an orinasal probe and a pulse oximetry finger probe to record PetCO2, oxygen saturation (SpO2), pulse rate, and respiratory rate. Arterial blood gas analysis was performed to record PaCO2 levels on three occasions at night (23: 00 pm, 03: 00 am, 07: 00 am). Results: The mean overnight PaCO2 level of the three blood gas analyses (mean PaCO2noct) was 41.78±4.69 mmHg. A significant change was observed between mean PaCO2 23: 00 and PaCO2 07: 00 levels (p=0.032). There was no significant difference between PaCO2, PetCO2, and SpO2 levels in the NMD group. The interclass correlation coefficient between PaCO2 07: 00 and PetCO2 levels was 0.791 (95% CI: 0.533-0.923); the interclass correlation coefficient between overnight mean PaCO2 and PetCO2 levels was 0.811 (95% CI: 0.533-0.923). Conclusion: Our study indicates that nocturnal PetCO2 and PaCO2 levels were statistically comparable but the use of PaCO2 alone is not adequate to make an early diagnosis of NH in NMD. There is a need for making more restrictive definitions for NH, and conducting studies with larger study populations to reach an agreement on the best definition of hypoventilation, and updating consensus guidelines.

show abstract

“…PetCO2 is also less accurate in the presence of high PaCO2 levels [20]. On the other hand, many studies have reported PetCO2 to be accurate for conditions in which the exhaled gas can be sampled within or close to the airways such as for patients whose alveolar dead space is not very large and, if using NIV/NVS, for those whose sampling is at the prongs, as in these cases, rather than via larger interfaces that dilute the sample [21]. In a study of 39 subjects with NMD, while maximum transcutaneous (Ptc) CO2 was 4 to 16 mmHg higher than EtCO2s, mean PtcCO2s was less than 1 mmHg to 7 mmHg greater [22].…”

Section: Discussionmentioning

confidence: 99%

Oxyhemoglobin desaturation as a function of age and hypercapnia from ventilatory pump failure (VPF)

Bach¹,

Pronello²

2020

Journal of Neurorestoratology

View full text Add to dashboard Cite

Background:Supplemental O2 is often administered without knowledge of CO2 levels for patients with ventilatory pump failure (VPF). This can render oximetry ineffective as a gauge of alveolar ventilation, airway secretions, and lung disease. We have noted that diurnal hypoventilation with hypercapnia tends to be symptomatic when O2 saturation levels decrease below 95% and patients extend sleep noninvasive ventilatory support (NVS) into daytime hours. We also noted that with advancing age, less hypercapnia results in desaturation. This study was designed to explore oxyhemoglobin desaturations (O2 desats) as a function of age and hypercapnia for patients with VPF.Methods:A retrospective analysis of 8933 consecutive patient visits for whom end-tidal CO2 and O2 sats were measured. O2 sats < 95% at CO2 levels of 45, 50, and 60 cmH2O were correlated with 10 years age intervals to age 80.Results:Of 8933 visits, 8642 had complete data. Outcomes for CO2 levels > 50 cmH2O were the most significant including for visit-ages < 30 and ≥ 30 years. There was a statistically significant 4% decrease in the odds of O2 desat for every one-year increase in age to age 30 (OR = 0.96, 95% CI = [0.93, 0.99], p = 0.02) and for visit-ages ≥ 30 a significant 30% increase in the odds of O2 desat for every 10-year increase in age (OR 1.3, 95% CI = [1.1, 1.6], p = 0.006). Relationship for ages ≥ 30 years were also significant for CO2 levels over 45 mmHg also. 40% of the time when CO2 was greater than 45 mmHg O2 sat was low.Discussion:This study demonstrated a significantly lower risk of O2 desat occurring at EtCO2 levels ≥ 50 mmHg for patients from 10 to 20 years of age than those younger than 10 and a significantly greater risk of O2 desat for 10 years intervals after age 20. Thus, with age, less hypercapnia results in desats and dyspnea with patients tending to extend NVS into daytime hours. This may be due to increases in physiological shunting, decreased pulmonary elasticity, and worsening ventilation/perfusion ratios with age.

show abstract

Sleep Transcutaneous vs. End-Tidal CO2 Monitoring for Patients with Neuromuscular Disease

Abstract: Maximum PtcCO2 was significantly greater than maximum PetCO2 for both groups and, therefore, tends to be higher than PetCO2 in this population. This should be taken into consideration when assessing patients for sleep hypoventilation.

Cited by 20 publications

References 27 publications

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Assessment of Nocturnal Hypoventilation by Different Methods and Definitions in Children with Neuromuscular Disease: Oxycapnography and Blood Gas Analysis

Oxyhemoglobin desaturation as a function of age and hypercapnia from ventilatory pump failure (VPF)

Contact Info

Product

Resources

About