Intensive Care Medicine

, Volume 35, Issue 6, pp 1068–1074 | Cite as

Carbon dioxide monitoring during long-term noninvasive respiratory support in children

  • Rebeca Paiva
  • Uros Krivec
  • Guillaume Aubertin
  • Emmanuelle Cohen
  • Annick Clément
  • Brigitte Fauroux
Original

Abstract

Introduction

Routine monitoring of noninvasive respiratory support relies on nocturnal pulse oximetry and daytime arterial blood gases, without systematic nocturnal carbon dioxide recording. The aim of the study was to assess if overnight pulse oximetry and daytime blood gases are sufficiently accurate to detect nocturnal hypoventilation in children receiving long-term noninvasive respiratory support.

Materials and methods

Pulse oximetry and carbon dioxide pressure measured by capillary arterialized blood gases and a combined transcutaneous carbon dioxide and pulse oximetry (PtcCO2/SpO2) monitor were compared in 65 patients (asthma, n = 16, recurrent bronchitis, n = 8, lung infection, n = 8, cystic fibrosis, n = 15, interstitial lung disease, n = 6, neuromuscular disease, n = 12). Daytime capillary arterialized blood gases and nocturnal recording of pulse oximetry and carbon dioxide by means of a combined PtcCO2/SpO2 monitor were performed in 50 other patients receiving nocturnal noninvasive respiratory support at home.

Results

A correlation was observed between pulse oximetry (r = 0.832, P < 0.0001) and carbon dioxide pressure (r = 0.644, P < 0.0001) measured by capillary arterialized blood gases and the combined PtcCO2/SpO2 monitor. Twenty-one of the 50 patients (42%) on long-term noninvasive respiratory support presented nocturnal hypercapnia, defined by a PtcCO2 value >50 mmHg, without nocturnal hypoxemia. Daytime capillary arterialized carbon dioxide levels were normal in 18 of these 21 patients.

Conclusions

Nocturnal hypercapnia may occur in children receiving nocturnal noninvasive respiratory support at home. Nocturnal pulse oximetry and daytime arterial blood gases are not sufficiently accurate to diagnose nocturnal hypercapnia, underlying the importance of a systematic carbon dioxide monitoring in children receiving noninvasive respiratory support.

Keywords

Carbon dioxide Noninvasive positive pressure ventilation Child Arterial blood gases 

References

  1. 1.
    Simonds A, Muntoni F, Heather S, Fielding S (1998) Impact of nasal ventilation on survival in hypercapnic Duchenne muscular dystrophy. Thorax 53:949–952PubMedCrossRefGoogle Scholar
  2. 2.
    Mellies U, Ragette R, Dohna Schwake C, Boehm H, Voit T, Teschler H (2003) Long-term noninvasive ventilation in children and adolescents with neuromuscular disorders. Eur Respir J 22:631–636PubMedCrossRefGoogle Scholar
  3. 3.
    Fauroux B, Pigeot J, Polkey MI, Roger G, Boulé M, Clément A, Lofaso F (2001) Chronic stridor caused by laryngomalacia in children. Work of breathing and effects of noninvasive ventilatory assistance. Am J Respir Crit Care Med 164:1874–1878PubMedGoogle Scholar
  4. 4.
    (1998) Management of pediatric patients requiring long-term ventilation. Chest 113:322S–336SGoogle Scholar
  5. 5.
    Berkenbosch JW, Lam J, Burd RS, Tobias JD (2001) Noninvasive monitoring of carbon dioxide during mechanical ventilation in older children: end-tidal versus transcutaneous techniques. Anesth Analg 92:1427–1431PubMedCrossRefGoogle Scholar
  6. 6.
    Cuvelier A, Grigoriu B, Molano LC, Muir JF (2005) Limitations of transcutaneous carbon dioxide measurements for assessing long-term mechanical ventilation. Chest 127:1744–1748PubMedCrossRefGoogle Scholar
  7. 7.
    Bolliger D, Steiner LA, Kasper J, Aziz OA, Filipovic M, Seeberger MD (2007) The accuracy of non-invasive carbon dioxide monitoring: a clinical evaluation of two transcutaneous systems. Anaesthesia 62:394–399PubMedCrossRefGoogle Scholar
  8. 8.
    Domingo C, Canturri E, Luján M, Moreno A, Espuelas H, Marín A (2006) Transcutaneous measurement of partial pressure of carbon dioxide and oxygen saturation: validation of the SenTec monitor. Arch Bronconeumol 42:246–251PubMedGoogle Scholar
  9. 9.
    Feiner JR, Severinghaus JW, Bickler PE (2007) Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender. Anesth Analg 105(6 Suppl):S18–S23PubMedCrossRefGoogle Scholar
  10. 10.
    Gaultier C, Boulé M, Allaire Y, Clément A, Burry A, Girard F (1978) Determination of capillary oxygen tension in infants and children: assessment of methodology and normal values during growth. Bull Eur Physiopath Resp 14:287–294Google Scholar
  11. 11.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedGoogle Scholar
  12. 12.
    Quanjer PH (1993) Standardized lung function testing. Eur Resp J 6(Suppl. 16):5s–30sGoogle Scholar
  13. 13.
    Fauroux B, Lavis JF, Nicot F, Picard A, Boelle PY, Clement A, Vazquez MP (2005) Facial side effects during noninvasive positive pressure ventilation in children. Intens Care Med 31:965–969CrossRefGoogle Scholar
  14. 14.
    Gonzalez J, Sharshar T, Hart N, Chadda K, Raphael JC, Lofaso F (2003) Air leaks during mechanical ventilation as a cause of persistent hypercapnia in neuromuscular disorders. Intens Care Med 29:596–602Google Scholar
  15. 15.
    Wallgren-Pettersson C, Bushby K, Mellies U, Simonds A (2004) 117th ENMC workshop: ventilatory support in congenital neuromuscular disorders—congenital myopathies, congenital muscular dystrophies, congenital myotonic dystrophy and SMA (II). Neuromuscular Disord 14:56–69CrossRefGoogle Scholar
  16. 16.
    Ward S, Chatwin M, Heather S, Simonds AK (2005) Randomised controlled trial of non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax 60:1019–1024PubMedCrossRefGoogle Scholar
  17. 17.
    Toussaint M, Chatwin M, Soudon P (2007) Mechanical ventilation in Duchenne patients with chronic respiratory insufficiency: clinical implications of 20 years published experience. Chron Respir Dis 4:167–177PubMedCrossRefGoogle Scholar
  18. 18.
    Milross MA, Piper AJ, Norman M, Willson GN, Grunstein RR, Sullivan CF, Bye PT (2001) Predicting sleep-disordered breathing in patients with cystic fibrosis. Chest 120:1239–1245PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Rebeca Paiva
    • 1
    • 3
    • 4
  • Uros Krivec
    • 2
    • 3
    • 4
  • Guillaume Aubertin
    • 3
  • Emmanuelle Cohen
    • 4
  • Annick Clément
    • 3
    • 4
  • Brigitte Fauroux
    • 3
    • 4
  1. 1.Pediatric Pulmonary DepartmentExequiel Gonzalez Cortes HospitalSantiagoChili
  2. 2.Unit for Pulmonary Diseases, Division of PediatricsUniversity Medical CenterLjubljanaSlovenia
  3. 3.Pediatric Pulmonary Department, AP-HP, Hôpital Armand Trousseau, Research Unit INSERM UMR-S 893 Equipe 12Université Pierre et Marie Curie-Paris6ParisFrance
  4. 4.INSERM UMR S-893 Equipe 12Université Pierre et Marie Curie-Paris6ParisFrance

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