Abstract
Background: In neuromuscular diseases (NMD), guidelines recommend initiation of home mechanical ventilation (HMV) in case of daytime hypercapnia or nocturnal desaturation as an indirect sign of hypoventilation. Transcutaneous capno-oxymetry (TcCO 2 ) enables the direct assessment of nocturnal hypercapnia, however the best cut-off values to be used remain to be defined. Aims: We aimed to compare the prognostic value of different definitions of nocturnal hypoventilation issued from the literature, in the NMD cohort followed at our reference center. Methods: All consecutive TcCO 2 recordings performed between 2010 and 2014 in non-ventilated adult NMD patients were retrospectively collected. Onset of mechanical ventilation and mortality were collected as outcomes of interest. Results: 124 patients with normal daytime blood gazes were analysed (age 39 [IQR 31-55] years; vital capacity 61% [43-82] of predicted). The prevalence of hypoventilation ranged from 3% to 44%, depending on the definition used. Over a median follow-up of 2.8 years, 55 patients (44%) were started on HMV and 4 died. Nocturnal peak TcCO 2 ≥49 mmHg was the best predictor of HMV onset during follow-up, identifying patients with a hazard ratio of 2.1 [95%CI 1.2-3.7] in multivariate analysis adjusting for lung function parameters. Conclusions: Nocturnal hypercapnia with daytime normocapnia seems to predict the need for HMV over the following few years. This may have practical consequences for the decision to start HMV in NMD patients. Nocturnal capno-oxymetry should be included in the consensus guidelines, and peak TcCO 2 should be considered as a criterion to start HMV both in clinical practice and in future prospective studies.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call