A comparison of arterial and transcutaneous carbon dioxide as a measure of nocturnal ventilatory efficacy during home mechanical ventilation.

COPD Non-invasive ventilation respiratory failure

Prof. dr. M.L. Duiverman
T. Raveling

Nature of the research:
Clinical research

Fields of study:
pulmonology intensive care

Background / introduction
Home mechanical ventilation (HMV) is the application of chronic ventilatory support at the patients home. HMV is a suitable treatment for patients with chronic type II respiratory failure (hypercapnic respiratory failure) due to a variety of aetiologies. In patients with end stage COPD who suffer from chronic hypercapnia, HMV can improve arterial blood gases, health-related quality of life and survival (1).
The aim of HMV in COPD is to reduce the nocturnal hypercapnia back to normal values (<6.0 kPa) (2). To measure the efficacy of the HMV, CO2 can be obtained from an arterial blood gas sample (PaCO2) or may be measured transcutaneous (TcCO2) using a device called a Sentec. Although the PaCO2 is the gold standard, the TcCO2 has a major advantage as it can be measured continuously during the night, so when a patient is on the HMV, and is non-invasive (3).
In research, statements regarding ventilatory efficacy are often made based on a single daytime PaCO2 sample. As the ventilatory capacity of end-stage COPD patients is severely limited, our experience is that the PaCO2 will rise quickly during the day, even if the nocturnal CO2 is adequately corrected by HMV. Therefore we think that the daytime PaCO2 sample not always a good way to measure of ventilatory efficacy during the night, and that the TcCO2 better represents ventilatory efficacy. So far, this has not be investigated properly.
Research question / problem definition
To determine if CO2 obtained from daytime arterial blood gas a good measure of nocturnal ventilatory efficacy, when compared to nocturnal transcutaneous CO2 measurement.
The aim is to compare the PaCO2 and TcCO2 measurements of approximately 100 patients. The data for this research project have been collected during the past years in 2 trials but require to be checked and analysed. As the data are already collected, this project of very well suitable for a masters research project.

In the Netherlands, HMV is organised in a unique way as only 4 centers facilitate this treatment. You will participate in our HMV team of the UMCG and the close group of clinical PhD students of the pulmonary department. You will have the opportunity to participate in the outpatient clinics and inpatient initiation on HMV, and are welcome to go on home visits with our specialised nursed. Furthermore, you will get the unique opportunity to learn about HMV, a very specialized area of care.

Daily supervision will be by a PhD student and a pulmonologist of the HMV center. The project will lead to a scientific publication in a high ranked journal, which you would be welcome to co-author.
Please feel free to contact us for more information.
1) Raveling T , Vonk J , Struik FM , Goldstein R , Kerstjens HAM , Wijkstra PJ , Duiverman ML . Chronic non-invasive ventilation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews TBD, Issue TBD. Art. No.: CD002878. DOI: 10.1002/14651858.CD002878.pub2.
2) Ergan B, Oczkowski S, Rochwerg B,et al. European Respiratory Society guidelines onlong-term home non-invasive ventilation for management of COPD.Eur Respir J 2019; 54: 1901003
3) Conway A, Tipton E, Liu W-H, et al. Thorax 2019;74:157–163.
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