Nocturnal home oxygen in the treatment of hypoxemic cystic fibrosis patients

Zinman, Raezelle; Corey, Mary; Coates, Allan L.; Canny, Gerard J.; Connolly, James G.; Levison, Henry; Beaudry, Pierre H.

doi:10.1016/s0022-3476(89)80553-0

Cited by 101 publications

(42 citation statements)

References 32 publications

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“…LTOT decreases or corrects pulmonary hypertension and the risk of cor pulmonale. In other diseases, such as CF, the benefit of LTOT has not been clearly established [23]. For children with a neuromuscular disease, particularly those with Duchenne's muscular dystrophy, MV may be detrimental when started too early before the onset of a severe restrictive lung disease [24].…”

Section: Discussionmentioning

confidence: 99%

Home treatment for chronic respiratory failure in children: a prospective study

Fauroux¹,

Sardet²,

Foret³

1995

Eur Respir J

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Home treatment for children with chronic respiratory failure (CRF) is increasing. However, the causes of CRF in children and the details of their home treatment are not well-known. The aim of this study was to describe the causes of CRF in the paediatric population and the treatments that the patients received at home. We surveyed all children (aged < or = 18 yrs) entering the Association Nationale pour le Traitement a Domicile de l'Insuffisance Respiratoire chronique (ANTADIR) for home treatment of CRF between March 1992 and March 1993. Two hundred and eighty seven children (178 boys, 62%) started home treatment for CRF during the year. One hundred and eleven patients had obstructive respiratory disease: cystic fibrosis (CF) (n = 24); bronchopulmonary dysplasia (BPD) (n = 79); other obstructive respiratory disease (n = 8). One hundred and seventy six patients had restrictive lung disease: neuromuscular disease (n = 87); kyphoscoliosis (n = 21); pulmonary fibrosis (n = 6); cardiac disease (n = 14); stomatological disease (n = 10); other restrictive respiratory disease (n = 9); and 29 miscellaneous causes. One hundred and thirteen patients received oxygen therapy, with a mean daily use of 17.7 h (20 h.day-1 for BPD patients and 12.3 h.day-1 for CF patients). Oxygen was delivered by a concentrator in 88% of cases. One hundred and fifty eight children received mechanical ventilation (MV). Five children received nasal continuous positive airway pressure ventilation for sleep apnoea, four had pneumatic belt ventilation, and 12 had a tracheostomy without MV. Treatment was stopped in 21 children, because of death in nine and improvement in the other 12. Home treatment for children with CRF is well developed in France via the ANTADIR network. Causes of CRF in children are heterogeneous, with a relatively good prognosis.

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Section: Discussionmentioning

confidence: 99%

Home treatment for chronic respiratory failure in children: a prospective study

Fauroux¹,

Sardet²,

Foret³

1995

Eur Respir J

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“…To assess the relative contributions of the look at home oxygen therapy 9 it was reported that, although the maximal work measured by different predictors of mortality, significant independent factors were entered into a multi-cycle ergometry was related to survival, the maximal oxygen uptake was not. More recently, variate logistic regression model as continuous variables.…”

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confidence: 99%

Exercise testing and prognosis in adult cystic fibrosis

Moorcroft

Dodd

Webb

1997

Thorax

119

117

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Abstracttus, 3 5 arterial P 2 , 4 6 Burkholderia cepacia colonisation, 7 8 and spirometric values 4 6 7 have Background -The assessment of prognosis is an important issue in cystic fib-been found to correlate with survival in cystic fibrosis. In a study of 673 patients Kerem et rosis. The prognostic value of exercise testing in comparison with other pre-al 4 found the forced expiratory volume in one second (FEV 1 ) to be the most significant predictors of mortality was examined. Methods -Ninety two adult patients with dictor, and that patients with an FEV 1 of less than 30% predicted had a 50% chance of dying cystic fibrosis performed progressive maximal exercise tests and outcome was as-within two years.The value of exercise testing in the assessed at five years. The results of exercise testing were examined along with spiro-sessment of prognosis in cystic fibrosis has been studied infrequently. 6 7 9 Patients attending the metric values, age, sex, body mass index (BMI), and sputum culture.adult cystic fibrosis unit in Manchester over the last decade have undergone routine maximal Results -Twenty two subjects died during the five year follow up period and 67 sur-exercise testing and we have investigated its prognostic value in comparison with previously vived. Five subjects received a lung transplant and were excluded from the analysis. described correlates of survival. This information may provide additional guidance in There were significant differences between those who survived and those who died: the assessment of prognosis in adults with cystic fibrosis. mean(SE) forced expiratory volume in one second (FEV 1 ) 68.9 (2.7) versus 39.7 (3.5)% predicted, BMI 19.0 (0.3) versus 17.1 (0.4) Methods kg/m 2 , peak oxygen uptake (V O 2 peak) 66. 6 The results of 92 patients who underwent ex-(2.2) versus 53.7 (3.7)% predicted, peak ercise testing between 1986 and 1989 in whom work rate (Wpeak) 89.4 (3.8) versus 71.2 the outcome at five years was known were (5.5)% predicted, peak minute ventilation retrospectively examined. Progressive in-(V Epeak) 51.3 (2.0) versus 43.3 (3.1) l/min, cremental exercise testing to a symptom limited and ventilatory equivalent for oxygen (V E/ maximum was performed using an elec-V O 2 ) 32.4 (0.6) versus 38.7 (1.7). Age, sex, tronically braked cycle ergometer (Corival 300, oxygen saturation and Burkholderia ceGould, The Netherlands). The work rate was pacia colonisation were not found to be increased each minute in either 15 or 25 watt significant predictors of mortality. When increments depending on the operator's assignificant independent factors were sessment of fitness and disease severity. Measentered into a multivariate logistic reurements taken included minute ventilation gression model only FEV 1 was found to be (V E), oxygen uptake (V  2 , Oxylog, P K Mora significant correlate of mortality. A cutgan, UK), work rate (W), oxygen saturation off for FEV 1 of 55% predicted gave the best (Sa 2 ; Ohmeda Biox 7300a), and heart rate combination of specificity and sensitivity (Hr; S ...

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“…However, in contrast with SPIER et al [3], low-flow oxygen was associated with significant increases in Ptc,CO 2 in our patients, and two patients reported morning headaches suggestive of clinically significant carbon dioxide retention. Despite the potential for development of severe hypercapnia and the uncertain value of long-term domiciliary oxygen therapy in CF [19], it has been our impression that low-flow oxygen remains the preferred modality of respiratory support by hypoxaemic CF patients. The long-term clinical implications of hypercapnia in these patients are, however, unclear.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal ventilatory support in patients with cystic fibrosis: comparison with supplemental oxygen

Gozal¹

1997

Eur Respir J

128

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Progressive deterioration of lung function in cystic fibrosis (CF) patients may lead to significant hypoxaemia and hypercapnia, especially during sleep. The effects of bi-level noninvasive positive pressure nasal mask ventilation (NIPPV) on respiration and sleep were compared to those of low-flow oxygen therapy in six CF patients (mean +/- SD age 22.3 +/- 4.7 yrs, with severe lung disease (forced expiratory volume in one second (FEV1) 29.4 +/- 3.4% predicted). Compared to the control night, NIPPV and oxygen therapy significantly improved overall night-time oxygen saturation during both rapid eye movement (REM) and non-rapid eye movement (NREM) sleep stages. However, significant increases in transcutaneous CO2 tension occurred during oxygen therapy, while NIPPV markedly improved alveolar ventilation during all sleep states. Sleep architecture and arousals remained unchanged during NIPPV and oxygen therapy treatment nights. We conclude that noninvasive positive pressure ventilation improves sleep-related hypoxaemia and hypercapnia in severe cystic fibrosis patients without affecting sleep. The long-term compliance and benefits of noninvasive positive pressure ventilation remain unclear.

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Nocturnal home oxygen in the treatment of hypoxemic cystic fibrosis patients

Cited by 101 publications

References 32 publications

Home treatment for chronic respiratory failure in children: a prospective study

Home treatment for chronic respiratory failure in children: a prospective study

Exercise testing and prognosis in adult cystic fibrosis

Nocturnal ventilatory support in patients with cystic fibrosis: comparison with supplemental oxygen

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