Article

OBJECTIVE: To determine the utility of home-based, unsupervised transcutaneous
partial pressure of carbon dioxide (tc-Pco(2)) monitoring/oxygen saturation by
pulse oximetry (Spo(2)) for detecting nocturnal hypoventilation (NH) in
individuals with neuromuscular disorders. DESIGN: Retrospective case series
analyzed consecutively. SETTING: Multidisciplinary neuromuscular respiratory
failure (NMRF) clinic at an academic institution. PARTICIPANTS: Subjects (N=35,
68.6% men; mean age, 46.9y) with spinal cord injury (45.7%) or other
neuromuscular disorders underwent overnight tests with tc-Pco(2)/Spo(2)
monitoring. Fifteen (42.9%) were using nocturnal ventilatory support, either
bilevel positive airway pressure (BiPAP) or tracheostomy ventilation (TV).
INTERVENTIONS: A respiratory therapist brought a calibrated tc-Pco(2)/Spo(2)
monitor to the patient's home and provided instructions for data collection
during the subject's normal sleep period. Forced vital capacity (FVC), body mass
index (BMI), and exhaled end-tidal Pco(2) (ET-Pco(2)) were recorded at a clinic
visit before monitoring. MAIN OUTCOME MEASURES: Detection of NH (tc-Pco(2)
>/=50mmHg for >/=5% of monitoring time). Data were also analyzed to determine
whether nocturnal oxygen desaturation (Spo(2) /=5% of monitoring
time), FVC, BMI, or daytime ET-Pco(2) could predict the presence of NH. RESULTS:
NH was detected in 18 subjects (51.4%), including 53.3% of those using BiPAP or
TV. NH was detected in 43.8% of ventilator-independent subjects with normal
daytime ET-Pco(2) (present for 49.4%+/-31.5% [mean +/- SD] of the study period),
and in 75% of subjects with an elevated daytime ET-Pco(2) (present for
92.3%+/-8.7% of the study period). Oxygen desaturation, BMI, and FVC were poor
predictors of NH. Only 3 attempted monitoring studies failed to produce
acceptable results. CONCLUSIONS: Home-based, unsupervised monitoring with
tc-Pco(2)/Spo(2) is a useful method for diagnosing NH in NMRF.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS