Home Overnight Gas Exchange for Long-Term Noninvasive Ventilation in Children

Abstract

BACKGROUND:

The aim of CPAP and noninvasive ventilation (NIV) is to correct sleep-disordered breathing and nocturnal gas exchange. The aim of the study was to analyze the results of a systematic home pulse oximetry ( ${\mathbf{\text{S}}}_{{\mathbf{\text{pO}}}_{\mathbf{\text{2}}}}$ ) and transcutaneous carbon dioxide ( ${\mathbf{\text{P}}}_{{\mathbf{\text{tcCO}}}_{\mathbf{\text{2}}}}$ ) monitoring in stable pediatric subjects on long-term CPAP/NIV or screened for CPAP/NIV weaning, and the consequent interventions in the subjects with abnormal gas exchange.

METHODS:

The home overnight ${\mathbf{\text{S}}}_{{\mathbf{\text{pO}}}_{\mathbf{\text{2}}}}$ and ${\mathbf{\text{P}}}_{{\mathbf{\text{tcCO}}}_{\mathbf{\text{2}}}}$ recordings of stable pediatric subjects treated with or weaned from CPAP, NIV, or high-flow nasal cannula between January 2017 and March 2018 were analyzed.

RESULTS:

A total of 110 recordings, performed in 79 subjects, median age 6 (interquartile range [IQR] 1.5–14) y, were analyzed. Fifty-two recordings (47%) were performed during NIV, 43 (39%) during CPAP, 2 (2%) during high-flow nasal cannula, and 13 (12%) during a spontaneous ventilation weaning trial from ventilatory support. The quality of recording was excellent in 81% of recordings, 5 recordings (5%) had <4 h of recording time, 5 (5%) had artifacts on the ${\mathbf{\text{S}}}_{{\mathbf{\text{pO}}}_{\mathbf{\text{2}}}}$ signal, and 16 (15%) had artifacts on the ${\mathbf{\text{P}}}_{{\mathbf{\text{tcCO}}}_{\mathbf{\text{2}}}}$ signal. Gas exchange abnormalities were observed in 11 subjects with ${\mathbf{\text{P}}}_{{\mathbf{\text{tcCO}}}_{\mathbf{\text{2}}}}$ > 50 mm Hg during ≥ 2% of recording time (n = 8), mean ${\mathbf{\text{P}}}_{{\mathbf{\text{tcCO}}}_{\mathbf{\text{2}}}}$ ≥ 50 mm Hg (n = 6), mean ${\mathbf{\text{P}}}_{{\mathbf{\text{tcCO}}}_{\mathbf{\text{2}}}}$ < 35 mm Hg (n = 3), and ${\mathbf{\text{S}}}_{{\mathbf{\text{pO}}}_{\mathbf{\text{2}}}}$ < 90% during ≥ 2% of recording time (n = 2). Consequent interventions were (multiple interventions possible): change of device settings (n = 6), change of interface (n = 2), switched to high-flow nasal cannula (n = 1), and a control recording (n = 2).

CONCLUSIONS:

A significant number (∼12%) of systematic home ${\mathbf{\text{S}}}_{{\mathbf{\text{pO}}}_{\mathbf{\text{2}}}}$ and ${\mathbf{\text{P}}}_{{\mathbf{\text{tcCO}}}_{\mathbf{\text{2}}}}$ recordings in stable pediatric subjects treated with CPAP/NIV were abnormal and may be corrected by adequate therapeutic interventions.