المؤلفون: Antoine, Léotard, Mathieu, Delorme, Vincent, Delord, Myriam, Niel-Duriez, David, Orlikowski, Djillali, Annane, Hélène, Prigent, Frédéric, Lofaso

المصدر: Chronic respiratory disease. 18

مصطلحات موضوعية: Muscular Dystrophy, Duchenne, Noninvasive Ventilation, Humans, Hypoventilation, Respiration, Artificial, Retrospective Studies

الوصف: Non-invasive ventilation (NIV) is the reference standard for managing chronic hypoventilation in patients with Duchenne muscular dystrophy (DMD). In these patients, upper airway obstruction under NIV may compromise efficacy and adherence. We aim to describe a novel pattern of expiratory obstructive events occurring during nocturnal barometric NIV.We retrospectively included all patients with DMD who underwent full-night polygraphy during NIV as part of their usual follow-up between May 2018 and July 2019.We provide a step-by-step description of this previously undescribed pattern of obstruction. Expiratory obstructions lead to end-inspiratory breath-holding and impossibility to take another inspiratory breath with a barometric mode until expiration occurs. These events were observed in 4 (36%) of 11 DMD patients under barometric NIV.Expiratory obstructions may be common in DMD patients receiving NIV and should be sought out routinely. This previously undescribed variant of obstructive event must be identified.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid________::751d670279c36c0e1171cd97842e3811Test
https://pubmed.ncbi.nlm.nih.gov/35289675Test

المؤلفون: Bruno Louis, Karl Leroux, Ghilas Boussaïd, Hélène Prigent, Frédéric Lofaso

المساهمون: Equipe de Recherche Paramédicale sur le Handicap NeuroMoteur (ERPHAN), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Saclay, Handicap neuromusculaire : Physiopathologie, Biothérapie et Pharmacologies appliquées (END-ICAP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Molecular virology and immunology – Physiopathology and therapeutic of chronic viral hepatitis (Team 18) (Inserm U955), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Biomécanique & Appareil Respiratoire (BAR), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS)

المصدر: Respiratory Care
Respiratory Care, Daedalus Enterprises Inc, 2020, 65 (9), pp.1258-1267. ⟨10.4187/respcare.07213⟩

مصطلحات موضوعية: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Central sleep apnea, Respiratory rate, [SDV]Life Sciences [q-bio], Hyperpnea, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, bench study, Tidal Volume, medicine, Humans, Cheyne-Stokes Respiration, Tidal volume, servomechanism, Continuous Positive Airway Pressure, lung model, adaptive servo ventilation, business.industry, pressure support, non-invasive ventilation, Hypoventilation, General Medicine, medicine.disease, Sleep Apnea, Central, 030228 respiratory system, Breathing, Cardiology, Transient (oscillation), medicine.symptom, business, Hypopnea

الوصف: BACKGROUND: Adaptive servoventilation (ASV) is a recently developed ventilation mode designed to stabilize ventilation in patients with central sleep apnea and Cheyne-Stokes respiration. Alternatively, modes aiming to maintain average ventilation over several breaths, such as average volume-assured pressure support (AVAPS) and intelligent volume-assured pressure support (iVAPS), could be efficient during ventilation instability by reducing central events. These modes are available on a variety of devices. This bench evaluation studied the response of these different modes and devices to simulated transient hypoventilation events. METHODS: Three home ventilation devices operating in ASV modes (AirCurve 10 CS Pacewave, ResMed; DreamStation autoSV, Philips; Prisma CR, Lowenstein) and 2 ventilators with the AVAPS mode (DreamStation BiPAP, Philips; Lumis 150 iVAPS, ResMed) were evaluated during transient central hypopnea/hypoventilation simulations characterized by a constant breathing frequency of 15 breaths/min and a progressive decrease of tidal volume (VT) from 500 mL to 50 mL, in 18, 12, 9, and 6 breaths, respectively, followed by a progressive return to the baseline at the same rate. RESULTS: The AirCurve 10 CS Pacewave reacted to a VT decrease between 80% and 50% of baseline VT. DreamStation BiPAP and Prisma CR reacted when VT decreased to between 60% and 30% of baseline VT, whereas the AVAPS response to hypopnea occurred during the crescendo phase of hypopnea/hypoventilation VT. The iVAPS response was between that of the AirCurve 10 CS Pacewave and the other ASV devices. Among the ASV devices, the minimum VT was higher with AirCurve 10 CS Pacewave, followed by the Prisma CR and the DreamStation BiPAP. Minimum VT was not influenced by AVAPS and was improved by iVAPS without outperforming the AirCurve 10 CS Pacewave. Maximum VT was increased by iVAPS, whereas ASV devices did not induce a significant VT overshoot. CONCLUSIONS: ASV devices improved central hypopnea/hypoventilation events without inducing hyperpnea events and therefore were better adapted than AVAPS and iVAPS devices, with notable differences in their responses to hypoventilation events.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1d1259b8e893b7c1304ed65eb49b4220Test
https://doi.org/10.4187/respcare.07213Test

المؤلفون: Hélène Prigent, David Orlikowski, Frédéric Lofaso, J. Nardi, Karl Leroux

المصدر: Chronic Respiratory Disease. 13:67-74

مصطلحات موضوعية: Pulmonary and Respiratory Medicine, Neuromuscular disease, Partial Pressure, 03 medical and health sciences, 0302 clinical medicine, Swallowing, medicine, Humans, 030212 general & internal medicine, Mouthpiece, Monitoring, Physiologic, Noninvasive Ventilation, business.industry, Neuromuscular Diseases, Original Articles, Carbon Dioxide, medicine.disease, Home Care Services, Peripheral, Hypoventilation, Treatment Outcome, 030228 respiratory system, Anesthesia, Breathing, medicine.symptom, business, Hypercapnia, Respiratory minute volume

الوصف: Mouthpiece ventilation (MPV) allows patients with neuromuscular disease to receive daytime support from a portable ventilator, which they can disconnect at will, for example, for speaking, eating, swallowing, and coughing. However, MPV carries a risk of underventilation. Our purpose here was to evaluate the effectiveness of daytime MPV under real-life conditions. Eight wheelchair-bound patients who used MPV underwent daytime polygraphy at home with recordings of airflow, mouthpiece pressure, thoracic and abdominal movements, peripheral capillary oxygen saturation (SpO2), and transcutaneous partial pressure of carbon dioxide (PtcCO2). Times and durations of tasks and activities were recorded. The Apnea–Hypopnea Index (AHI) was computed. Patient–ventilator disconnections ≥3 minutes and episodes of hypoventilation defined as PtcCO2>45 mmHg were counted. Patient–ventilator asynchrony events were analyzed. The AHI was >5 hour−1 in two patients. Another patient experienced unexplained 3% drops in arterial oxygen saturations at a frequency of 70 hour−1. Patient–ventilator disconnections ≥3 minutes occurred in seven of eight patients and were consistently associated with decreases in SpO2 and ≥5-mmHg increases in PtcCO2; PtcCO2 rose above 45 mmHg in two patients during these disconnections. The most common type of patient–ventilator asynchrony was ineffective effort. This study confirms that MPV can be effective as long as the patient remains connected to the mouthpiece. However, transient arterial oxygen desaturation and hypercapnia due to disconnection from the ventilator may occur, without inducing unpleasant sensations in the patients. Therefore, an external warning system based on a minimal acceptable value of minute ventilation would probably be useful.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fab4ae8201e93a0e0f4bf709e9168854Test
https://doi.org/10.1177/1479972315619575Test

المؤلفون: Ghassane Mroue, Isabelle Vaugier, Adam Ogna, David Orlikowski, Djillali Annane, Hélène Prigent, Maria-Antonia Quera Salva, Frédéric Lofaso

المصدر: Sleep and Breathing. 20:575-581

مصطلحات موضوعية: Adult, Male, Pediatrics, medicine.medical_specialty, Neuromuscular disease, medicine.medical_treatment, Concordance, Population, 03 medical and health sciences, 0302 clinical medicine, Oxygen therapy, medicine, Humans, Oximetry, education, Retrospective Studies, Acid-Base Equilibrium, Mechanical ventilation, education.field_of_study, business.industry, Hypoventilation, Neuromuscular Diseases, Middle Aged, medicine.disease, Circadian Rhythm, Cross-Sectional Studies, 030228 respiratory system, Otorhinolaryngology, Respiratory failure, Female, Neurology (clinical), medicine.symptom, Respiratory Insufficiency, business, Blood Gas Monitoring, Transcutaneous, Hypercapnia, 030217 neurology & neurosurgery

الوصف: Restrictive respiratory failure is a major cause of morbidity and mortality in neuromuscular diseases (NMD). Home mechanical ventilation (HMV) is used to treat hypoventilation, identified by daytime hypercapnia or nocturnal desaturation. Recently, transcutaneous measure of CO2 (TcCO2) has been increasingly used to detect hypoventilation, using different cut-offs. We aimed to compare the prevalence of hypoventilation in an unselected adult NMD population according to different definitions issued from the literature. All consecutive nocturnal capno-oximetries performed between 2010 and 2014 in unventilated adult NMD patients were analysed retrospectively. Concomitant blood gas analysis and lung function data were collected. Patients on oxygen therapy were excluded. Hypoventilation was defined according to eight criteria, based on daytime PaCO2, daytime base excess, nocturnal SpO2 or TcCO2. Data from 232 patients were analysed (mean age 43.1 ± 15.4 years; 50.0 % women; vital capacity 59.2 ± 24.2 % of predicted). The hypoventilation prevalence was 10.3 to 61.2 %, depending on the used definition. The different definitions showed 49.1 to 94.8 % concordance (Cohen’s kappa for agreement 0.115 to 0.763). Overall agreement between the eight definitions was poor (Light’s kappa 0.267), and agreement between definitions based on nocturnal SpO2 and those based on TcCO2 was even lower (Light’s kappa 0.204). We found large differences in hypoventilation prevalence according to the used definition. This has practical consequences, as HMV indication relies upon hypoventilation detection. We believe that capno-oximetry should be included in the diagnostic tools used to detect hypoventilation but this requires an update of consensus guidelines to agree upon the best definition.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8809fe080f2fde651150efe5e587acdbTest
https://doi.org/10.1007/s11325-015-1247-2Test

المؤلفون: Christophe Perrin, Magalie Mercy, Anne Perel-Jaillet, Arnaud Prigent, Frederic Claude, S. Pontier, Laure Goubert-Bennet, Claudio Rabec, Marjolaine Georges, L. Mounier, Sandrine Jaffre, Boris Melloni, Kamila Sedkaoui, Anne Mallart, Jean-François Muir, Romain Kessler, Didier Foret, Capucine Morélot-Panzini, Frank Lavergne, Frédéric Gagnadoux, Pierre Cervantes, Hélène Prigent, Antoine Cuvelier, Gilles Hilbert, Claudia Llontop, Jésus Gonzalez

المصدر: Rehabilitation and Chronic Care.

مصطلحات موضوعية: medicine.medical_specialty, COPD, Respiratory rate, business.industry, medicine.disease, Hypoventilation, Internal medicine, Diabetes mellitus, Epidemiology, Cohort, medicine, Etiology, Arterial blood, medicine.symptom, business

الوصف: The effectiveness of home NIV for chronic respiratory failure (CRF) is well established. However, little data is available about its epidemiology. The ANTADIR-GAV cohort is aimed to prospectively analyze data from patients initiated to home NIV in France. Methods: Multicentric prospective observational study. Etiology of CRF, demographic data, comorbidities, NIV setting, arterial blood gases, type/parameters of ventilator and interface were collected. Results: From 5/2015 to 12/2016, 964 patients (54% male, age 64±14 y, BMI 28±10 kg/m²) were included in 19 centers. CRF resulted from neuromuscular (51%), thoracic cage (24%) or parenchyma (25%) impairment. The most frequent etiologies were amyotrophic lateral sclerosis (36%), COPD (22%) and obesity hypoventilation (19%). Main comorbidities were hypertension (40%), diabetes (18%), arrhythmia (13%) and coronary heart disease (8%). Before NIV initiation PaO2 was 73±14 and PaCO2 49 ±8 mmHg. Most patients used single circuit pressure ventilators with calibrated leak (99%) and most used modes ST (83%), S (10%) and hybrid (4%). NIV was introduced in 892 patients using a bilevel ventilator without battery (47%) or with battery (45%). A life support ventilator was needed in 8% patients. IPAP, EPAP and backup respiratory rate were respectively 16±4 cmH2O, 7±3 cmH20 and 15±3 c/min. Preferred interface was an orofacial mask (80%). Additional oxygen was needed in 32% patients. NIV was introduced after acute respiratory failure in 43% patients and electively in 57% Conclusion: This cohort gives new insights about recent trends in home NIV practice in France. Recruiting is being pursued and adherence /survival data will be secondarily assessed.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::cad0795d0ee4a6be7977f94c494db45bTest
https://doi.org/10.1183/1393003.congress-2017.pa3692Test

المؤلفون: Frédéric Lofaso, Nicholas Heming, Cendrine Chaffaut, David Orlikowski, Maria-Antonia Quera Salva, Adam Ogna, Sylvie Chevret, Djillali Annane, Hélène Prigent

المصدر: Neuromuscular disorders : NMD. 27(4)

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Vital capacity, Neuromuscular disease, medicine.medical_treatment, Nocturnal, Hypercapnia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Genetics (clinical), Mechanical ventilation, business.industry, Hazard ratio, Hypoventilation, Neuromuscular Diseases, Middle Aged, medicine.disease, Prognosis, Respiration, Artificial, Surgery, 030228 respiratory system, Neurology, Pediatrics, Perinatology and Child Health, Cohort, Cardiology, Female, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, Follow-Up Studies

الوصف: In neuromuscular disease (NMD) patients, current guidelines recommend the initiation of home mechanical ventilation (HMV) in case of daytime hypercapnia or nocturnal desaturation as an indirect sign of hypoventilation. Transcutaneous capno-oximetry (TcCO 2 ) enables the direct assessment of nocturnal hypercapnia; however the best cut-off value remains to be defined. We aimed to compare the prognostic value of several published definitions of nocturnal hypercapnia in a cohort of NMD patients. All consecutive TcCO 2 recordings performed between 2010 and 2014 in unventilated adult NMD patients in a tertiary reference centre were retrospectively collected. Initiation of HMV and mortality were collected as outcomes of interest. 124 patients with normal daytime blood gazes were analysed (median age 39 [IQR 31–55] years; vital capacity 61% [43–82] of predicted). The prevalence of nocturnal hypercapnia ranged from 3% to 44%, depending on the definition. Over a median follow-up duration of 2.5 years [IQR 1.6–4.1], HMV was initiated for 51 patients, whilst 4 patients died. Nocturnal peak TcCO 2 ≥49 mmHg was the best predictor of HMV initiation in the follow-up, being associated with a hazard ratio of 2.6 [95% CI 1.4–4.6] in a multivariate analysis adjusting for lung function parameters. Nocturnal TcCO 2 identifies NMD patients at risk for subsequent need for HMV in the following few years, who were not identified by daytime blood gases or nocturnal oximetry. As a consequence, peak nocturnal TcCO 2 ≥49 mmHg should be considered as one of the criteria to start HMV in patients with NMDs, along with symptoms of hypoventilation, daytime hypercapnia, abnormal nocturnal oximetry results, and a diminished level of forced vital capacity.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c1b7f29db3b91b2e5bcb9b3870b6ca72Test
https://pubmed.ncbi.nlm.nih.gov/28153460Test

المؤلفون: Sylvie Chevret, Djillali Annane, Nicholas Heming, David Orlikowski, Hélène Prigent, Frédéric Lofaso, Adam Ogna, Maria-Antonia Quera Salva

المصدر: 2.2 Noninvasive Ventilatory Support.

مصطلحات موضوعية: Mechanical ventilation, medicine.medical_specialty, Neuromuscular disease, business.industry, medicine.medical_treatment, Hazard ratio, medicine.disease, Hypoventilation, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Internal medicine, Cohort, medicine, Cardiology, Normocapnia, medicine.symptom, Intensive care medicine, business, Prospective cohort study, Hypercapnia, 030217 neurology & neurosurgery

الوصف: 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.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::1c8379ec6d1bb91cd450b46813e3cd91Test
https://doi.org/10.1183/13993003.congress-2016.pa2170Test

المؤلفون: Christophe Perrin, Marie-Cécile Niérat, Thomas Similowski, Jésus Gonzalez-Bermejo, Philippe Couratier, Catherine Fargeot, Claude Desnuelle, Capucine Morélot-Panzini, Marie-Laure Tanguy, Timothée Lenglet, Gaëlle Bruneteau, Catherine Royer, Valérie Attali, Vincent Meininger, François Salachas, Nathalie Guy, Nadine Le Forestier, Pierre-François Pradat, Hélène Prigent, Fabrice Menegaux

المصدر: The Lancet. Neurology. 15(12)

مصطلحات موضوعية: Male, medicine.medical_specialty, Population, Diaphragm, Electric Stimulation Therapy, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Double-Blind Method, law, medicine, Humans, Respiratory system, education, Phrenic nerve, Aged, education.field_of_study, business.industry, Amyotrophic Lateral Sclerosis, Middle Aged, Respiration Disorders, Respiration, Artificial, Hypoventilation, Diaphragm (structural system), Surgery, Phrenic Nerve, Diaphragm pacing, 030228 respiratory system, Respiratory failure, Anesthesia, Early Termination of Clinical Trials, Female, Laparoscopy, Neurology (clinical), medicine.symptom, business, Respiratory Insufficiency, 030217 neurology & neurosurgery

الوصف: Summary Background Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder associated with respiratory muscle weakness and respiratory failure. Non-invasive ventilation alleviates respiratory symptoms and prolongs life, but is a palliative intervention. Slowing the deterioration of diaphragm function before respiratory failure would be desirable. We aimed to assess whether early diaphragm pacing could slow down diaphragm deterioration and would therefore delay the need for non-invasive ventilation. Methods We did a multicentre, randomised, controlled, triple-blind trial in patients with probable or definite ALS in 12 ALS centres in France. The main inclusion criterion was moderate respiratory involvement (forced vital capacity 60–80% predicted). Other key eligibility criteria were age older than 18 years and bilateral responses of the diaphragm to diagnostic phrenic stimulation. All patients were operated laparoscopically and received phrenic stimulators. Clinicians randomly assigned patients (1:1) to receive either active or sham stimulation with a central web-based randomisation system (computer-generated list). Investigators, patients, and an external outcome allocation committee were masked to treatment. The primary outcome was non-invasive ventilation-free survival, analysed in the intention-to-treat population. Safety outcomes were also assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01583088. Findings Between Sept 27, 2012, and July 8, 2015, 74 participants were randomly assigned to receive either active (n=37) or sham (n=37) stimulation. On July 16, 2015, an unplanned masked analysis was done after another trial showed excess mortality with diaphragm pacing in patients with hypoventilation (DiPALS, ISRCTN 53817913). In view of this finding, we analysed mortality in our study and found excess mortality (death from any cause) in our active stimulation group. We therefore terminated the study on July, 16, 2015. Median non-invasive ventilation-free survival was 6·0 months (95% CI 3·6–8·7) in the active stimulation group versus 8·8 months (4·2–not reached) in the control (sham stimulation) group (hazard ratio 1·96 [95% CI 1·08–3·56], p=0·02). Serious adverse events (mainly capnothorax or pneumothorax, acute respiratory failure, venous thromboembolism, and gastrostomy) were frequent (24 [65%] patients in the active stimulation group vs 22 [59%] patients in the control group). No treatment-related death was reported. Interpretation Early diaphragm pacing in patients with ALS and incipient respiratory involvement did not delay non-invasive ventilation and was associated with decreased survival. Diaphragm pacing is not indicated at the early stage of the ALS-related respiratory involvement. Funding Hospital Program for Clinical Research, French Ministry of Health; French Patients' Association for ALS Research (Association pour la Recherche sur la Sclerose Laterale Amyotrophique); and Thierry de Latran Foundation.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::19a260bb434838c0442a1dfe0bf80b1bTest
https://pubmed.ncbi.nlm.nih.gov/27751535Test

المؤلفون: David Orlikowski, Hélène Prigent, J. Nardi, Sylvie Chevret, Djillali Annane, Adam Ogna, Maria-Antonia Quera Salva, Frédéric Lofaso

المصدر: 2.2 Noninvasive Ventilatory Support.

مصطلحات موضوعية: Mechanical ventilation, business.industry, medicine.medical_treatment, Duchenne muscular dystrophy, Hazard ratio, Follow up studies, medicine.disease, Hypoxemia, Hypoventilation, Anesthesia, Oxygen therapy, Medicine, medicine.symptom, business, Hypercapnia

الوصف: Background: Home mechanical ventilation (HMV) is used to treat hypoventilation, and its efficacy is mostly assessed by daytime blood gases and nocturnal oximetry (SpO2). Transcutaneous CO2 measure (TcCO2) has shown higher sensitivity than SpO2 to detect hypoventilation in neuromuscular diseases (NMD) patients. No data exists on the prognostic value of these techniques. Aims: We aimed to compare the prognostic value of SpO2 and TcCO2 in ventilated adult NMD patients. Methods: Capno-oximetries performed between 2009 and 2011 in ventilated adult NMD patients were analyzed retrospectively and classified as showing “hypoxemia”, “hypercapnia” or being “normal”. Patients on oxygen therapy were excluded. Time to first ICU admission or death was collected as outcome of interest. Results: 55 patients were analyzed (age 28 [IQR 25-36.5] years; 71% Duchenne muscular dystrophy; vital capacity 11.5 [7.25-27.25] % of predicted; 51% tracheostomy). Capno-oxymetry was normal in 67% of patients, showing hypoxemia in 15% and hypercapnia in 27%. 9% had both hypoxemia and hypercapnia. Over a median follow-up of 4 years, we observed 12 deaths and 21 ICU admissions. The diagnosis-adjusted hazard ratio (95%CI) for mortality or ICU admission was 2.93 (1.24-6.91, p=0.01) for hypercapnia and 2.31 (0.85-6.23, p=0.10) for hypoxemia, when compared to the group with normal capno-oxymetry. Conclusions: Residual hypoventilation, assessed by capno-oximetry, has a negative prognostic impact in adult ventilated NMD patients. Accordingly, we suggest that capno-oxymetry should be included in the assessment of HMV efficacy in NMD patients, since TcCO2 identifies more patients at risk than oximetry alone.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::b90fd9b3e8012e8ff716210deebb5dd7Test
https://doi.org/10.1183/13993003.congress-2015.oa4781Test

المؤلفون: Frédéric Lofaso, Stéphane Bahrami, Dante Santos Brasil, David Orlikowski, Hélène Prigent, Ghilas Boussaïd

المصدر: Neuromuscular Disorders. 28:194

مصطلحات موضوعية: 0301 basic medicine, medicine.medical_specialty, medicine.medical_treatment, Myotonic dystrophy, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Internal medicine, medicine, Respiratory function, Genetics (clinical), Mechanical ventilation, business.industry, Non invasive, Perspective (graphical), medicine.disease, Hypoventilation, 030104 developmental biology, Neurology, Pediatrics, Perinatology and Child Health, Cardiology, Noninvasive ventilation, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::aeb45c17e5bef78d30584cb14e2cc364Test
https://doi.org/10.1016/j.nmd.2017.12.004Test