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Ayhan Y, Yuksel Karatoprak E, Onay ZR, Can Oksay S, Girit S. Assessment of Nocturnal Hypoventilation by Different Methods and Definitions in Children with Neuromuscular Disease: Oxycapnography and Blood Gas Analysis. Medeni Med J 2021; 36:106-116. [PMID: 34239762 PMCID: PMC8226400 DOI: 10.5222/mmj.2021.42385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/24/2021] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Yetkin Ayhan
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Elif Yuksel Karatoprak
- Istanbul Medeniyet University, Faculty of Medicine, Depatment of Pediatric Neurology, Istanbul, Turkey
| | - Zeynep Reyhan Onay
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Sinem Can Oksay
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Saniye Girit
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
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Amaddeo A, Moreau J, Frapin A, Khirani S, Felix O, Fernandez-Bolanos M, Ramirez A, Fauroux B. Long term continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) in children: Initiation criteria in real life. Pediatr Pulmonol 2016; 51:968-74. [PMID: 27111113 DOI: 10.1002/ppul.23416] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Long term noninvasive continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are increasingly used in children but limited information is available on the criteria and conditions leading to the initiation of these treatments. The aim of the study is to describe the objective overnight respiratory parameters and clinical situations that led to the initiation of CPAP/NIV in a pediatric NIV unit. MATERIAL AND METHODS Retrospective analysis of the data of all the children discharged on home CPAP/NIV over a 1 year period. RESULTS Seventy-six patients were started on CPAP (n = 64) or NIV (n = 12). CPAP/NIV was initiated because of CPAP/NIV weaning failure (Acute group) in 15 patients. None of these patients had an overnight gas exchange or sleep study before CPAP/NIV initiation. In 18 patients, CPAP/NIV was initiated on abnormal nocturnal gas exchange alone (Subacute group). These patients had a median of three of the following five overnight gas exchange abnormalities: minimal pulse oximetry (SpO2 ) <90%, maximal transcutaneous carbon dioxide (PtcCO2 ) >50 mmHg, time spent with SpO2 <90% or PtcCO2 >50 mmHg ≥2% of recording time, oxygen desaturation index >1.4/hr. In the last 43 patients, CPAP/NIV was initiated after an abnormal sleep study (Chronic group) on a mean of four of the aforementioned criteria and an apnea-hypopnea index >10/hr. CONCLUSION In clinical practice, CPAP/NIV was initiated in an acute, subacute and chronic setting with most patients having an association of several abnormal gas exchange or sleep study parameters. Future studies should evaluate the effectiveness and benefits of CPAP/NIV according to the clinical situation and initiation criteria. Pediatr Pulmonol. 2016; 51:968-974. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- A Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,Paris Descartes University, Paris, France.,Inserm U955 Team 13, 94000, Creteil, France
| | - J Moreau
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,Department of Physiology, University of Montpellier I, Montpellier, France
| | - A Frapin
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France
| | - S Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,ASV Santé, Gennevilliers, France
| | - O Felix
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,Department of Pediatric, CHU de Rouen, Rouen, France
| | - M Fernandez-Bolanos
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France
| | - A Ramirez
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,ADEP ASSISTANCE, Suresnes, France
| | - B Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,Paris Descartes University, Paris, France.,Inserm U955 Team 13, 94000, Creteil, France
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Khirani S, Ramirez A, Olmo-Arroyo J, Amaddeo A, Quijano-Roy S, Desguerre I, Fauroux B. [Are respiratory muscle testing helpful to prompt sleep studies in children with neuromuscular disease?]. Med Sci (Paris) 2015; 31 Spec No 3:14-7. [PMID: 26546925 DOI: 10.1051/medsci/201531s304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sonia Khirani
- Chercheur, ASV Santé, Gennevilliers et Unité de ventilation non invasive et du sommeil de l'enfant, Hôpital Necker-Enfants malades, Paris
| | - Adriana Ramirez
- Ingénieur de recherche, ADEP Assistance, Suresnes, et Unité de ventilation non invasive et du sommeil de l'enfant, Hôpital Necker-Enfants malades, Paris
| | - Jorge Olmo-Arroyo
- Technicien de recherche subventionné AFM, Unité de ventilation non invasive et du sommeil de l'enfant, Hôpital Necker-Enfants malades, Paris
| | - Alessandro Amaddeo
- Chef de clinique, Unité de ventilation non invasive et du sommeil de l'enfant, Hôpital Necker-Enfants malades, Paris
| | - Susana Quijano-Roy
- Neuropédiatre, Centre de Référence Maladies Neuromusculaires (GNMH), Hôpital Raymond Poincaré, Garches, Université Versailles UVSQ, Inserm, UMRS1176, Montigny-le-Bretonneau
| | - Isabelle Desguerre
- Neuropédiatre, Centre de Référence Maladies Neuromusculaires (GNMH), Hôpital Necker-Enfants malades, Paris, Université Paris Descartes
| | - Brigitte Fauroux
- Pneumo-pédiatre, Unité de ventilation non invasive et du sommeil de l'enfant, Hôpital Necker-Enfants malades, Paris, Université Paris Descartes, Inserm U955, Équipe 13, Créteil
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Capnography for assessing nocturnal hypoventilation and predicting compliance with subsequent noninvasive ventilation in patients with ALS. PLoS One 2011; 6:e17893. [PMID: 21479202 PMCID: PMC3068132 DOI: 10.1371/journal.pone.0017893] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 02/14/2011] [Indexed: 11/29/2022] Open
Abstract
Background Patients with amyotrophic lateral sclerosis (ALS) suffer from hypoventilation, which can easily worsen during sleep. This study evaluated the efficacy of capnography monitoring in patients with ALS for assessing nocturnal hypoventilation and predicting good compliance with subsequent noninvasive ventilation (NIV) treatment. Methods Nocturnal monitoring and brief wake screening by capnography/pulse oximetry, functional scores, and other respiratory signs were assessed in 26 patients with ALS. Twenty-one of these patients were treated with NIV and had their treatment compliance evaluated. Results Nocturnal capnography values were reliable and strongly correlated with the patients' respiratory symptoms (R2 = 0.211–0.305, p = 0.004–0.021). The duration of nocturnal hypercapnea obtained by capnography exhibited a significant predictive power for good compliance with subsequent NIV treatment, with an area-under-the-curve value of 0.846 (p = 0.018). In contrast, no significant predictive values for nocturnal pulse oximetry or functional scores for nocturnal hypoventilation were found. Brief waking supine capnography was also useful as a screening tool before routine nocturnal capnography monitoring. Conclusion Capnography is an efficient tool for assessing nocturnal hypoventilation and predicting good compliance with subsequent NIV treatment of ALS patients, and may prove useful as an adjunctive tool for assessing the need for NIV treatment in these patients.
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Abstract
This is a summary of the presentation on the assessment of sleep-disordered breathing in pediatric neuromuscular diseases, presented as part of the program on pulmonary management of pediatric patients with neuromuscular disorders at the 30th annual Carrell-Krusen Neuromuscular Symposium on February 20, 2008.
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Affiliation(s)
- Sherri L Katz
- Children's Hospital of Eastern Ontario, Division of Respirology, University of Ottawa, Ottawa, Ontario, Canada K1H 8L1.
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Brissot R, Gonzalez-Bermejo J, Lassalle A, Desrues B, Doutrellot PL. Fatigue and respiratory disorders. ACTA ACUST UNITED AC 2006; 49:320-30, 403-12. [PMID: 16780993 DOI: 10.1016/j.annrmp.2006.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 04/03/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To analyze the factors at the origin of fatigue in respiratory disorders. To assess fatigue and its functional impact on patients affected from respiratory diseases. To evaluate the results of comprehensive care on fatigue and functional capacity. MATERIALS AND METHODS We systematically reviewed the literature in Medline and the Cochrane Library, using the following keywords: fatigue, respiratory disorders, questionnaire, evaluation, assessment, randomized controlled trial, meta-analysis. RESULTS Fatigue is a high frequency symptom (90%) and takes an important place, as much as dyspnea, in the genesis of the respiratory induced handicap. Its assessment is varied, according to the studies. It originates from multiple causes, as shown from clinical and experimental studies. The main treatment consists in rehabilitation, using physical exercises. Its efficacy is demonstrated on physical endurance, but is not clear in terms of general fatigue. CONCLUSION Although fatigue is very frequent complaint, along with a major disabling condition, the comprehensive assessment of fatigue, in respiratory disorders, including its physical and cognitive components, is not still really codified. Rehabilitation is the main treatment. Its efficiency has been demonstrated on the physical and functional components of fatigue. Its results on perceived fatigue remains to be evaluated.
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Affiliation(s)
- R Brissot
- Service de Médecine Physique et de Réadaptation, Hôpital de Pontchaillou, CHU de Rennes, France.
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Neuromuscular Disorders and Sleepiness. Sleep Med Clin 2006. [DOI: 10.1016/j.jsmc.2005.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Schäfer T. [Method for measuring respiration in sleep: capnography for determining ventilation]. BIOMED ENG-BIOMED TE 2003; 48:170-5. [PMID: 12861657 DOI: 10.1515/bmte.2003.48.6.170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ventilation serves the exchange of gases between the organism and the environment. Oxygen uptake and CO2 elimination are controlled by feedback loops, that keep fluctuations in arterial CO2 pressure (PaCO2) within narrow limits Disorders in the central regulation of breathing, or impairment of the respiratory apparatus, may result in a mismatch between metabolic CO2 production and ventilatory CO2, elimination and thus in fluctuations in the PaCO2: inappropriately increased ventilation (hyperventilation) causes hypocapnia, and reduced ventilation (hypoventilation) causes hypercapnia. In order to detect such disorders during sleep, PCO2 measurement is of great importance, but direct and continuous measurement of the PaCO2 is invasive and thus unsuitable in the clinical setting. An alternative is capnography, the continuous measurement of PCO2 in inhaled and exhaled air on the basis of ultrared light absorption. This paper reviews the method, its features and limitations, and the possibilities of improving capnography to better detect sleep-related breathing disorders. In addition, data obtained from 57 patients with predominantly normal lung function, but suspected sleep disordered breathing are presented. Simultaneous measurements of capnography PETCO2) and capillary PaCO2 revealed a PETCO2 difference of +0.63 +/- 3.3 (SD) Torr. PaCO2 (38.8 +/- 4.1 Torr) and PETCO2 (38.1 +/- 4.3 Torr) were not significantly different with a correlation coefficient of r = 0.68 (p < 0.001). Thus 46% of the variation in PETCO2 was explained by changes in PaCO2. Currently the literature contains few further data on capnography during sleep. It is concluded that, provided the limitations of the method are respected and comparison with the PETCO2 is made, capnography may be a useful, noninvasive and continuous measuring method for assessing ventilation during sleep in patients with suspected sleep related breathing disorders.
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Affiliation(s)
- T Schäfer
- Abteilung für Angewandte Physiologie, Ruhr-Universität Bochum.
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