• David Orlikowski, Hélène Prigent, Frédéric Lofaso, Annie Adala, Mikaëlle Bohic, François Lebargy, and Maria-Antonia Quera-Salva.
• Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale et Centre d'Investigation Clinique et d'Innovation Technologique, Unité 805 Institut National de la Santé et de la Recherche Médicale, Hôpital Raymond Poincaré, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France. jnardi@chu-reims.fr
• Resp Care. 2012 Sep 1;57(9):1425-30.

BackgroundPulse oximetry alone has been suggested to determine which patients on home mechanical ventilation (MV) require further investigation of nocturnal gas exchange. In patients with neuromuscular diseases, alveolar hypoventilation (AH) is rarely accompanied with ventilation-perfusion ratio heterogeneity, and, therefore, oximetry may be less sensitive for detecting AH than in patients with lung disease.ObjectiveTo determine whether pulse oximetry (S(pO(2))) and transcutaneous carbon dioxide (P(tcCO(2))) during the same night were interchangeable or complementary for assessing home MV efficiency in patients with neuromuscular diseases.MethodsData were collected retrospectively from the charts of 58 patients with chronic neuromuscular respiratory failure receiving follow-up at a home MV unit. S(pO(2)) and P(tcCO(2)) were recorded during a 1-night hospital stay as part of standard patient care. We compared AH detection rates by P(tcCO(2)), S(pO(2)), and both.ResultsAH was detected based on P(tcCO(2)) alone in 24 (41%) patients, and based on S(pO(2)) alone with 3 different cutoffs in 3 (5%), 8 (14%), and 13 (22%) patients, respectively. Using both P(tcCO(2)) and S(pO(2)) showed AH in 25 (43%) patients.ConclusionsPulse oximetry alone is not sufficient to exclude AH when assessing home MV efficiency in patients with neuromuscular diseases. Both P(tcCO(2)) and S(pO(2)) should be recorded overnight as the first-line investigation in this population.Copyright 2012 Daedalus Enterprises

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