Home Overnight Gas Exchange For Long-Term Noninvasive Ventilation In Children

BACKGROUND: The aim of CPAP and noninvasive ventilation (NIV) is to correct sleep-disordered breathing and nocturnal gas exchange. The aim of the study was to analyze the results of a systematic home pulse oximetry (S-pO2) and transcutaneous carbon dioxide (P-tcCO2) monitoring in stable pediatric subjects on long-term CPAP/NIV or screened for CPAP/NIV weaning, and the consequent interventions in the subjects with abnormal gas exchange. METHODS: The home overnight S-pO2 and P-tcCO2 recordings of stable pediatric subjects treated with or weaned from CPAP, NIV, or high-flow nasal cannula between January 2017 and March 2018 were analyzed. RESULTS: A total of 110 recordings, performed in 79 subjects, median age 6 (interquartile range [IQR] 1.5-14) y, were analyzed. Fifty-two recordings (47%) were performed during NIV, 43 (39%) during CPAP, 2 (2%) during high-flow nasal cannula, and 13 (12%) during a spontaneous ventilation weaning trial from ventilatory support. The quality of recording was excellent in 81% of recordings, 5 recordings (5%) had <4 h of recording time, 5 (5%) had artifacts on the S-pO2 signal, and 16 (15%) had artifacts on the P-tcCO2 signal. Gas exchange abnormalities were observed in 11 subjects with P-tcCO(2) >= 50 mm Hg during >= 2% of recording time (n = 8), mean P-tcCO2 >= 50 mm Hg (n = 6), mean P-tcCO2 < 35 mm Hg (n = 3), and S-pO2 < 90% during >= 2% of recording time (n = 2). Consequent interventions were (multiple interventions possible): change of device settings (n = 6), change of interface (n = 2), switched to high-flow nasal cannula (n = 1), and a control recording (n = 2). CONCLUSIONS: A significant number (similar to 12%) of systematic home S-pO2 and P-tcCO(2) recordings in stable pediatric subjects treated with CPAP/NIV were abnormal and may be corrected by adequate therapeutic interventions.