title: Nocturnal oximetry and transcutaneous carbon dioxide in home-ventilated neuromuscular patients.
abstract: BACKGROUND
  Pulse oximetry alone has been suggested to determine which patients on home mechanical ventilation (MV) require further investigation of nocturnal gas exchange. In patients with neuromuscular diseases, alveolar hypoventilation (AH) is rarely accompanied with ventilation-perfusion  ratio heterogeneity, and, therefore, oximetry may be less sensitive for detecting AH than in patients with lung disease.
  
  
  OBJECTIVE
  To determine whether pulse oximetry (S(pO(2))) and transcutaneous carbon dioxide (P(tcCO(2))) during the same night were interchangeable  or complementary for assessing home MV efficiency in patients with neuromuscular diseases.
  
  
  METHODS
  Data were collected retrospectively from the charts of 58 patients with chronic neuromuscular respiratory failure receiving follow-up at a home MV unit. S(pO(2)) and P(tcCO(2))  were recorded during a 1-night hospital stay as part of standard patient care. We compared AH detection rates by P(tcCO(2)), S(pO(2)), and both.
  
  
  RESULTS
  AH was detected based on P(tcCO(2)) alone in 24 (41%) patients, and based on S(pO(2))  alone with 3 different cutoffs in 3 (5%), 8 (14%), and 13 (22%) patients, respectively. Using both P(tcCO(2)) and S(pO(2)) showed AH in 25 (43%) patients.
  
  
  CONCLUSIONS
  Pulse oximetry alone is not sufficient to exclude AH when assessing home MV efficiency  in patients with neuromuscular diseases. Both P(tcCO(2)) and S(pO(2)) should be recorded overnight as the first-line investigation in this population.
authors.affiliation: Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale et Centre d'Investigation Clinique et d'Innovation Technologique, Unité 805 Institut National de la Santé et de la Recherche Médicale, Hôpital Raymond Poincaré, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France. jnardi@chu-reims.fr
authors.forename: Julie
authors.initials: J
authors.lastname: Nardi
authors.forename: Hélène
authors.initials: H
authors.lastname: Prigent
authors.forename: Annie
authors.initials: A
authors.lastname: Adala
authors.forename: Mikaëlle
authors.initials: M
authors.lastname: Bohic
authors.forename: François
authors.initials: F
authors.lastname: Lebargy
authors.forename: Maria-Antonia
authors.initials: MA
authors.lastname: Quera-Salva
authors.forename: David
authors.initials: D
authors.lastname: Orlikowski
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lofaso
mesh_terms: D000328:Adult; D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous; D005260:Female; D006801:Humans; D007040:Hypoventilation / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult