Clinical and Pulmonary Function Markers of Respiratory Exacerbation Risk in Subjects With Quadriplegic Cerebral Palsy.
BACKGROUND
Although respiratory exacerbations are common in patients with quadriplegic cerebral palsy (CP), little is known about the factors that are related to increased exacerbation risk. This study aimed to identify the clinical and pulmonary function variables signaling risk of exacerbation in this type of patient.


METHODS
Thirty-one children and young adults with quadriplegic CP underwent a comprehensive history, physical examination, and pulmonary function test, including arterial blood gas analysis, airway resistance using the interrupter technique, and home overnight SpO2 monitoring. Subjects were divided into 2 groups depending on the number of respiratory exacerbations reported during the year before study entry: frequent exacerbators (ie, ≥ 2 exacerbations) and infrequent exacerbators (ie, < 2 exacerbations).


RESULTS
The frequent exacerbators were more likely to require hospitalization due to respiratory disorders compared with the infrequent exacerbators (13/14 vs 9/17, P = .02). Respiratory exacerbation was found to be associated with diagnosis of gastroesophageal reflux (adjusted odds ratio of 23.95 for subjects with confirmed diagnosis, P = .02) and higher PaCO2 levels (adjusted odds ratio of 12.60 for every 5-mm Hg increase in PaCO2 , P = .05). Subjects with PaCO2 ≥ 35 mm Hg showed an exacerbation odds ratio of 15.2 (95% CI 1.5-152.5, P = .01).


CONCLUSIONS
Gastroesophageal reflux and increased PaCO2 can be considered simple, clinically useful markers of increased exacerbation risk in young subjects with quadriplegic CP.
Respiratory Pathophysiology Division, City Hospital of Padova, Padova, Italy. avianello@qubisoft.it.
Andrea
A
Vianello
Neuropediatric Rehabilitation Unit, E Medea Scientific Institute, Conegliano, Italy.
Elena
E
Carraro
Department of Formative Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Emanuela
E
Pipitone
Department of Neurosciences, Otolaryngology Unit, University of Padova, Padova, Italy.
Rosario
R
Marchese-Ragona
Respiratory Pathophysiology Division, City Hospital of Padova, Padova, Italy.
Giovanna
G
Arcaro
Respiratory Pathophysiology Division, City Hospital of Padova, Padova, Italy.
Marco
M
Ferraro
Respiratory Pathophysiology Division, City Hospital of Padova, Padova, Italy.
Luciana
L
Paladini
Neuropediatric Rehabilitation Unit, E Medea Scientific Institute, Conegliano, Italy.
Andrea
A
Martinuzzi
D000293:Adolescent; D000886:Anthropometry; D015415:Biomarkers / Q000032:analysis*; D001784:Blood Gas Analysis; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology*; D002648:Child; D018450:Disease Progression; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012129:Respiratory Function Tests / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology*; D012307:Risk Factors
D015415:Biomarkers
arterial blood gases; cerebral palsy; gastroesophageal reflux; pulmonary function test; pulmonary rehabilitation; respiratory exacerbation