title: Efficiency of invasive mechanical ventilation during sleep in Duchenne muscular dystrophy.
abstract: OBJECTIVE
  Inspiratory unintentional leaks (IULs) during noninvasive ventilation (NIV) adversely affect the sleep and the effectiveness of mechanical ventilation (MV). The aim of this study was to assess the effects of nocturnal IULs in Duchenne muscular dystrophy (DMD) patients with a tracheostomy and uncuffed tube comparatively with NIV patients.
  
  
  METHODS
  Polysomnography with transcutaneous partial pressure of carbon dioxide (PtcCO(2)) recording and blood gas measurement was performed in 26 stable tracheostomized DMD patients using home MV, among whom 11 were matched with NIV patients.
  
  
  RESULTS
  IULs occurred during 29.4% [1.7-61.9%] (median [IQR]) of the total sleep time. By univariate regression analysis, the closest correlation with IUL duration was for daytime base excess (r(2)=0.69, P<0.0001), followed by daytime bicarbonate level. In a stepwise multiple regression analysis, only base excess remained significantly correlated. Sleep and respiratory parameters improved in the four patients who agreed to use cuffed tubes. Tracheostomized patients had lower maximal PtcCO(2) (P=0.02) and base excess values (P=0.045) compared to NIV controls.
  
  
  CONCLUSIONS
  Tracheostomy does not guarantee that MV is effective during sleep, as IULs may occur, but ensures better nocturnal gas exchanges than NIV. DMD patients should be evaluated using at least blood gas measurement, nocturnal oximetry, and PtcCO(2) monitoring.
authors: Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale et Centre d'Investigation Clinique et d'Innovation Technologique (Unité Inserm 805), Université de Versailles Saint-Quentin-en-Yvelines (EA 4497), Hôpital Raymond Poincaré, AP-HP, 92380 Garches, France.
authors: Julie
authors: J
authors: Nardi
authors: Hélène
authors: H
authors: Prigent
authors: Betty
authors: B
authors: Garnier
authors: François
authors: F
authors: Lebargy
authors: Maria-Antonia
authors: MA
authors: Quera-Salva
authors: David
authors: D
authors: Orlikowski
authors: Frédéric
authors: F
authors: Lofaso
mesh_terms: D000328:Adult; D000077463:Carbamide Peroxide; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D006801:Humans; D001239:Inhalation; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000150:complications / Q000628:therapy*; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000379:methods / Q000592:standards; D010545:Peroxides / Q000097:blood; D017286:Polysomnography / Q000295:instrumentation / Q000379:methods; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012893:Sleep Wake Disorders / Q000209:etiology*; D014139:Tracheostomy / Q000295:instrumentation / Q000379:methods*; D014508:Urea / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D010545:Peroxides; D002245:Carbon Dioxide; D000077463:Carbamide Peroxide; D014508:Urea