Source: Annual Congress 2002 - Assessment of lung function, telemonitoring and quality of life
Disease area: Respiratory critical care, Sleep and breathing disorders

Abstract

Aim of study: To determine the predictive value of daytime ABG and NPO for the detection of nocturnal hypercapnia (defined as: Mean PtcCO2 > 45 mmHg) in patients treated by HMV.
Methods: Prospective multicentric study. Daytime ABG were measured with and w/o ventilator. Nocturnal monitoring included NPO, and 8-hour transcutaneous recording of PtcCO2 (Radiometer Tina TCM3.®).
Results: 64 patients (34F, 30M) were included, ventilated for obstructive (22%) or restrictive (78%) chronic respiratory failure. PFT (Mean±]SD) were: FEV1: 46±]21% of predicted; FEV1/FVC%: 75±]21% ; PaCO2 (mmHg): 47±]8 w/o ventilator and 42±]8 with ventilator; nocturnal PtcCO2: 46±]12 mmHg; nocturnal SaO2: 93±]4% (58% of patients had O2 supplementation). Correlation between daytime PaCO2 and nocturnal PtcCO2 was : r2=.45 (p<.0001) for PaCO2 w/o ventilator, and: r2=.68 with ventilator (p<.0001). Bias (d) and limits of agreement between daytime PaCO2 and mean nocturnal PtcCO2 were (mmHg): 1.0 (-17.6 ; + 18.6) for PaCO2 w/o ventilator and : -3 (-19 ; + 13) for PaCO2 with ventilator. Sensitivity (Se), PPV and NPV of a daytime PaCO2 > 45 mmHg for detecting nocturnal hypoventilation were : 73%, 73% and 70% for values w/o ventilator and 61%, 82% and 67% for values with ventilator. Se, PPV and NPV for NPO were much lower.
Conclusion: Nocturnal PtcCO2 and daytime ABG are significantly correlated, with a small bias, but limits of agreement are wide; daytime ABG explain at best 68% of the variance of nocturnal PtcCO2; relying on NPO and daytime ABG may underestimate the frequency and severity of nocturnal hypercapnia in HMV.

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J. P. Janssens, A. Héritier-Praz, O. Staneczek, L. Burdet, J. W. Fitting, C. Uldry, J. M. Tschopp, T. Rochat (Geneva, Lausanne, Rolle, Crans-Montana, Switzerland). Agreement between daytime measurement of arterial blood gases (ABG), nocturnal pulse-oximetry (NPO) and transcutaneous capnography (PtcCO2) in home mechanical ventilation (HMV). Eur Respir J 2002; 20: Suppl. 38, 996

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