Utility of Transcutaneous Capnography for Optimization of Non-Invasive Ventilation Pressures
Introduction: Nocturnal Non-invasive Positive Pressure Ventilation (NPPV) is the treatment of choice in patients with chronic hypercapnic respiratory failure due to hypoventilation. Continuous oxygen saturation measured with a pulse oximeter provides a surrogate measure of arterial oxygen satura...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2016-09-01
|
| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/8514/19911_CE[Ra1]_F(GH)_PF1(ROAK)_PFA(AK)_PF2(PEK).pdf |
| Summary: | Introduction: Nocturnal Non-invasive Positive Pressure
Ventilation (NPPV) is the treatment of choice in patients with
chronic hypercapnic respiratory failure due to hypoventilation.
Continuous oxygen saturation measured with a pulse oximeter
provides a surrogate measure of arterial oxygen saturation
but does not completely reflect ventilation. Currently, Partial
Pressure of Arterial (PaCO2) measured by arterial blood analysis
is used for estimating the adequacy of ventilatory support and
serves as the gold standard
Aim: To examine the safety, feasibility and utility of cutaneous
capnography to re-titrate the non-invasive positive pressure
ventilation settings in patients with chronic hypercapnic
respiratory failure due to hypoventilation.
Materials and Methods: Twelve patients with chronic
hypercapnic respiratory failure prospectively underwent
complete polysomnography and cutaneous capnography
measurement on the ear lobe. Non-invasive ventilation pressures
were adjusted with the aim of normalizing cutaneous carbon
dioxide or at least reducing it by 10 to 15 mmHg. Sensor drift for
cutaneous carbon dioxide of 0.7 mmHg per hour was integrated
in the analysis.
Results: Mean baseline cutaneous carbon dioxide was 45.4
+ 6.5 mmHg and drift corrected awake value was 45.1 + 8.3
mmHg. The correlation of baseline cutaneous carbon dioxide
and the corrected awake cutaneous carbon dioxide with arterial
blood gas values were 0.91 and 0.85 respectively. Inspiratory
positive airway pressures were changed in nine patients (75%)
and expiratory positive airway pressures in eight patients (66%).
Epworth sleepiness score before and after the study showed
no change in five patients, improvement in six patients and
deterioration in one patient.
Conclusion: Cutaneous capnography is feasible and permits
the optimization of non-invasive ventilation pressure settings
in patients with chronic hypercapnic respiratory failure due to
hypoventilation. Continuous cutaneous capnography might
serve as an important additional tool to complement diurnal
arterial carbon dioxide tension values. |
|---|---|
| ISSN: | 2249-782X 0973-709X |