Severe Hypercapnia After Low-Flow Oxygen Therapy in Patients With Neuromuscular Disease and Diaphragmatic Dysfunction
Section snippets
PATIENTS AND METHODS
On review of the individual medical records of 118 consecutive adult patients, encountered during a 5-year period, who underwent phrenic nerve conduction studies and had a diagnosis of neuromuscular disease, we found 8 in whom results of the phrenic nerve conduction studies were abnormal and in whom repeated arterial blood gases (ABGs) were determined with the patient in the awake state before and after supplemental oxygen therapy. For these eight patients, demographic information, disease
RESULTS
A summary of the clinical and respiratory data for the study patients is shown in Table 1. The ABG responses before and after administration of supplemental oxygen and the time at which the tests were done are itemized in Table 2. The results of the phrenic nerve stimulation and diaphragmatic EMG response, the type of treatment, and the outcome of the study patients are summarized in Table 3. The mean age of the patients was 57 years, and the mean FVC, MVV, and Pimax were considerably decreased
DISCUSSION
Although this patient population had a variety of neuromuscular disorders, all patients had decreased or absent diaphragmatic EMG responses and moderate to severe reductions in the FVC. When admitted with the chief complaint of dyspnea, all patients were given low-flow oxygen therapy, and seven of the eight patients exhibited moderate to severe hypoxia and hypercapnia on initial ABG studies. Follow-up ABGs were determined primarily after changes in mental status and in three cases led to
CONCLUSION
Regardless of the underlying mechanisms for hypoventilation, data from the current study support the concept that, in patients with neuromuscular disease who have demonstrated diaphragmatic dysfunction and hypercapnia, supplemental oxygen therapy should be very closely monitored. Physicians should ideally repeat ABG studies after 60 minutes or less of supplemental oxygen therapy and be alert to the possibility of a substantial increase in the Paco2, level, especially if patients have
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