Sleep Transcutaneous vs. End-Tidal CO2 Monitoring for Patients with Neuromuscular Disease

Abstract

OBJECTIVE: This study compared transcutaneous carbon dioxide partial pressure (PtcCO2) and end-tidal carbon dioxide partial pressure (PetCO2) monitoring during sleep for patients with neuromuscular disease. DESIGN: This is a retrospective study of patients whose PtcCO2 and PetCO2 were monitored before they began using noninvasive mechanical ventilation. The outcomes were divided into four groupings: group 1, both PtcCO2 and PetCO2 are greater than or equal to 49 mm Hg; group 2, PtcCO2 is greater than or equal to 49 mm Hg but PetCO2 is less than 49 mm Hg; group 3, PtcCO2 is less than 49 mm Hg but PetCO2 is greater than or equal to 49 mm Hg; and group 4, both PtcCO2 and PetCO2 are less than 49 mm Hg. RESULTS: A total of 39 subjects (mean [SD] age, 27.7 [19.3] yrs) were enrolled. PtcCO2 values were significantly higher than PetCO2 values (P < 0.001). The intraclass correlation coefficient between maximal and mean values of PtcCO2 and PetCO2 was 0.612 and 0.718, respectively. Bias and limits of agreement between PtcCO2 and PetCO2 were -7.5 mm Hg and -21.3 to 6.3 mm Hg for maximal values and -4.8 mm Hg and -14.8 to 5.3 mm Hg for mean values. Group 2 included 19 (48.7%) and group 3 included 3 (7.6%) patients who showed discrepancy of hypercapnia between two methods. CONCLUSIONS: Maximum PtcCO2 was significantly greater than maximum PetCO2 for both groups and, therefore, tends to be higher than PetCO2 in this population. This should be taken into consideration when assessing patients for sleep hypoventilation.