Adam Ogna1, Maria-Antonia Quera Salva2, Helene Prigent3, Ghassane Mroue2, Isabelle Vaugier4, Djillali Annane5, Frederic Lofaso2,3, David Orlikowski5,4. 1. Service de Réanimation médicale et unité de ventilation à domicile, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France. adam.ogna@rpc.aphp.fr. 2. Unité du Sommeil, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France. 3. Service de Physiologie-Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France. 4. INSERM CIC 14.29, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France. 5. Service de Réanimation médicale et unité de ventilation à domicile, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France.
Abstract
PURPOSE: Restrictive respiratory failure is a major cause of morbidity and mortality in neuromuscular diseases (NMD). Home mechanical ventilation (HMV) is used to treat hypoventilation, identified by daytime hypercapnia or nocturnal desaturation. Recently, transcutaneous measure of CO2 (TcCO2) has been increasingly used to detect hypoventilation, using different cut-offs. We aimed to compare the prevalence of hypoventilation in an unselected adult NMD population according to different definitions issued from the literature. METHODS: All consecutive nocturnal capno-oximetries performed between 2010 and 2014 in unventilated adult NMD patients were analysed retrospectively. Concomitant blood gas analysis and lung function data were collected. Patients on oxygen therapy were excluded. Hypoventilation was defined according to eight criteria, based on daytime PaCO2, daytime base excess, nocturnal SpO2 or TcCO2. RESULTS: Data from 232 patients were analysed (mean age 43.1 ± 15.4 years; 50.0 % women; vital capacity 59.2 ± 24.2 % of predicted). The hypoventilation prevalence was 10.3 to 61.2 %, depending on the used definition. The different definitions showed 49.1 to 94.8 % concordance (Cohen's kappa for agreement 0.115 to 0.763). Overall agreement between the eight definitions was poor (Light's kappa 0.267), and agreement between definitions based on nocturnal SpO2 and those based on TcCO2 was even lower (Light's kappa 0.204). CONCLUSIONS: We found large differences in hypoventilation prevalence according to the used definition. This has practical consequences, as HMV indication relies upon hypoventilation detection. We believe that capno-oximetry should be included in the diagnostic tools used to detect hypoventilation but this requires an update of consensus guidelines to agree upon the best definition.
PURPOSE: Restrictive respiratory failure is a major cause of morbidity and mortality in neuromuscular diseases (NMD). Home mechanical ventilation (HMV) is used to treat hypoventilation, identified by daytime hypercapnia or nocturnal desaturation. Recently, transcutaneous measure of CO2 (TcCO2) has been increasingly used to detect hypoventilation, using different cut-offs. We aimed to compare the prevalence of hypoventilation in an unselected adult NMD population according to different definitions issued from the literature. METHODS: All consecutive nocturnal capno-oximetries performed between 2010 and 2014 in unventilated adult NMD patients were analysed retrospectively. Concomitant blood gas analysis and lung function data were collected. Patients on oxygen therapy were excluded. Hypoventilation was defined according to eight criteria, based on daytime PaCO2, daytime base excess, nocturnal SpO2 or TcCO2. RESULTS: Data from 232 patients were analysed (mean age 43.1 ± 15.4 years; 50.0 % women; vital capacity 59.2 ± 24.2 % of predicted). The hypoventilation prevalence was 10.3 to 61.2 %, depending on the used definition. The different definitions showed 49.1 to 94.8 % concordance (Cohen's kappa for agreement 0.115 to 0.763). Overall agreement between the eight definitions was poor (Light's kappa 0.267), and agreement between definitions based on nocturnal SpO2 and those based on TcCO2 was even lower (Light's kappa 0.204). CONCLUSIONS: We found large differences in hypoventilation prevalence according to the used definition. This has practical consequences, as HMV indication relies upon hypoventilation detection. We believe that capno-oximetry should be included in the diagnostic tools used to detect hypoventilation but this requires an update of consensus guidelines to agree upon the best definition.
Authors: Michelle Eagle; Simon V Baudouin; Colin Chandler; David R Giddings; Robert Bullock; Kate Bushby Journal: Neuromuscul Disord Date: 2002-12 Impact factor: 4.296
Authors: David J Berlowitz; Jo Spong; Fergal J O'Donoghue; Rob J Pierce; Douglas J Brown; Donald A Campbell; Peter G Catcheside; Ian Gordon; Peter D Rochford Journal: Respir Care Date: 2011-01-21 Impact factor: 2.258
Authors: C E Jackson; J Rosenfeld; D H Moore; W W Bryan; R J Barohn; M Wrench; D Myers; L Heberlin; R King; J Smith; D Gelinas; R G Miller Journal: J Neurol Sci Date: 2001-10-15 Impact factor: 3.181