Validity of transcutaneous PCO 2 in monitoring chronic hypoventilation treated with non-invasive ventilation

Aarrestad, Sigurd; Tollefsen, Elin; Kleiven, Anne Louise; Qvarfort, Magnus; Janssens, Jean–Paul; Skjønsberg, Ole Henning

doi:10.1016/j.rmed.2016.01.017

Cited by 58 publications

(48 citation statements)

References 52 publications

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“…Transcutaneous capnography has undergone recent improvements regarding ease of use and software application. It is considered reliable for clinical use and allows an early detection and quantification of nocturnal hypoventilation in routine respiratory practice without requiring arterial blood sampling during sleep [56, 57]. End-tidal CO 2 is another noninvasive way to estimate PaCO 2 ; it is, however, considered unreliable in subjects with chronic respiratory disease and is not recommended for this setting [58].…”

Section: Respiratory Muscle Strengthmentioning

confidence: 99%

The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity

Adler

Janssens²

2018

Respiration

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The purpose of this review is to provide an overview on how interactions between control of breathing, respiratory load, and muscle function may lead to respiratory failure. The mechanisms involved vary according to the underlying pathology, but respiratory failure is most often the result of an imbalance between the muscular pump and the mechanical load placed upon it. Changes in respiratory drive and response to CO₂ seem to be important contributors to the pathophysiology of respiratory failure. Inspiratory muscle dysfunction is also frequent but is not a mandatory prerequisite to respiratory failure since increased load may also be sufficient to precipitate it. It is crucial to recognize these interactions to be able to timeously establish patients on mechanical ventilation and adapt the ventilator settings to their respiratory system physiology.

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Section: Respiratory Muscle Strengthmentioning

confidence: 99%

The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity

Adler

Janssens²

2018

Respiration

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“…It was therefore considered by our group as an indication for daytime ventilatory support as an extension of nocturnal ventilation . Baseline SpO 2 and TcCO 2 were recorded self‐ventilating at the end of the afternoon via an ear clip connected to a Sentec monitoring (SenTec AG, Therwil, Swizerland) . Subjects reported spontaneous breathing time defined as the time of comfortable breathing without the support of NIV during the daytime.…”

Section: Methodsmentioning

confidence: 99%

Preference of neuromuscular patients regarding equipment for daytime mouthpiece ventilation: A randomized crossover study

Toussaint¹,

Chatwin

Verhulst

et al. 2019

Clinical Respiratory J

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Background Patients with neuromuscular disorders (NMDs) are likely to develop respiratory failure which requires noninvasive ventilation (NIV). Ventilation via a mouthpiece (MPV) is an option to offer daytime NIV. Objectives To determine the preferred equipment for MPV by patients with NMDs. Methods Two MPV equipment sets were compared in 20 patients with NMDs. Set 1, consisted of a non‐dedicated ventilator for MPV (PB560, Covidien) with a plastic angled mouthpiece. Set 2, consisted of a dedicated MPV ventilator (Trilogy 100, Philips Respironics) without backup rate and kiss trigger combined with a silicone straw mouthpiece. The Borg dyspnea score, ventilator free time, transcutaneous oxygen saturation (SpO2) and carbon dioxide tension (TcCO2) were recorded with and without MPV. Patient perception was assessed by a 17‐items list. Results Carbon dioxide tension measurements and total perception score were not different between the two MPV sets. Dyspnea score was lower with the non‐dedicated versus dedicated equipment, 1 (0.5) versus 3 (1‐6), P < 0.01. All patients with a ventilator free time lower than 6 hours preferred a set backup rate rather than a kiss trigger. Sixty five percent of patients preferred the commercial arm support and 55% preferred the plastic angled mouthpiece. Conclusions Dedicated and non‐dedicated MPV equipment are deemed effective and comfortable. Individualization of arm support and mouthpiece is advised to ensure success of MPV. A ventilator free time lower than 6 hours seems to be a useful indicator to a priori set a backup rate rather than a rate at zero associated to the kiss trigger.

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“…Transcutaneous monitoring of carbon dioxide (p tc CO 2 ) is a valid method to non-invasively and continuously monitor changes of p tc CO 2 during NIV [43]. The level of agreement with p a CO 2 is acceptable and the great advantage is the possibility to monitor trends over time non-invasively [44].…”

Section: Monitoringmentioning

confidence: 99%

Frontiers in Clinical Practice of Long-Term Care of Chronic Ventilatory Failure

Schwarz

Bloch

2019

Respiration

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Home mechanical ventilation (HMV) is an effective long-term treatment for chronic hypercapnic respiratory failure. In addition to the established practice of providing HMV for the treatment of chronic ventilatory failure in slowly progressive neuromuscular and chest wall disease, there is accumulating evidence for improvement of quality of life and prolongation of survival by HMV in highly prevalent diseases like chronic obstructive pulmonary disease and ever-increasing obesity hypoventilation syndrome as well as rapidly progressive neuromuscular disease. The key concepts for successful HMV are an experienced team selecting the right patients, timely initiation of adequate ventilation via an appropriate interface, and monitoring effectiveness during regular long-term follow-up. Coaching of patients with chronic respiratory failure on long-term HMV within a dedicated service and collaborations with community services for home care are essential. The current review describes various important practical aspects of HMV that remain frontiers in the implementation of the current knowledge in clinical practice and may help in providing effective HMV to all those in need.

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Validity of transcutaneous PCO 2 in monitoring chronic hypoventilation treated with non-invasive ventilation

Abstract: With the device tested, in stable patients under NIV-treatment for CRF, PtcCO2 accurately reflects PaCO2. PtcCO2 can be used to monitor CO2 overnight during NIV without any clinically significant drift. TRIAL REGISTRATION N°: NCT01845233.

Cited by 58 publications

References 52 publications

The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity

The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity

Preference of neuromuscular patients regarding equipment for daytime mouthpiece ventilation: A randomized crossover study

Frontiers in Clinical Practice of Long-Term Care of Chronic Ventilatory Failure

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