Daytime Hypercapnia, Oximeter Alarm

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curiousgeorge
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Daytime Hypercapnia, Oximeter Alarm

Postby curiousgeorge » Mon Dec 07, 2015 1:48 am

My 27-year-old daughter (with a congenital myopathy) who has been using her nasal NVS for sleep every night and for brief daytime periods for years (and has a vital capacity of about 240 mL and can walk short distances) saw her pulmonologist today and an arterial blood gas came back PaCO2 87, pH 7.19 so they just called me and told me to go the Emergency Room because her blood is too acidic and she is going into acute respiratory failure or at least to come back to the office on Monday. When I check her O2 sats during the day they are generally normal so I am surprised. What should I do?

(Asked by a parent)

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bachjr
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Re: Daytime Hypercapnia, Oximeter Alarm

Postby bachjr » Mon Dec 07, 2015 1:51 am

Her daytime O2 sats are generally normal because she breathes deeper while you are checking them, but the rest of the day they are in the low 90s and her CO2 is high. If you go to the emergency room or back to their office, then they will give her oxygen; her CO2 will go over 120 and she will stop breathing, be intubated, and then they will tell you she cannot be extubated without getting a tracheostomy tube as happened 8 years ago when she was transferred to us for extubation without one. Although she is not losing much VC every year, she is getting older and needs more respiratory reserve to maintain her blood gases. Continuing to use sleep NVS and NVS for only brief periods during the day is no longer adequate.

She needs to wear an oximeter with the alarm set at 94% so that every time her O2 sat goes below 95%, she knows that she has to take a few deeper breaths, and as she tires, she can use mouthpiece or nasal NVS for rest periods during the daytime as well. She must use the oximeter as feedback all day with her O2 sat over 94% all day, the CO2 will be good, and no one will be passing tubes into her airways. When walking, she either needs to use long tubing or put the ventilator on the rolling walker tray to use mouthpiece or nasal NVS.

JB
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School


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