Surveillance et monitorage de la ventilation à l'hôpital et au domicile

Monitoring during non-invasive ventilation (NIV) in patients with neuromuscular disease is required and influences the prognosis. It starts with clinical aspects. Indeed, diagnosis of persistant symptoms of alveolar hypoventilation, and assessment of tolerance and compliance, are of major importance. Furthermore, diurnal arterial blood gases on room air are mandatory. For example, a daytime PaC02 below 50 mm Hg may be associated with better survival. Oximetry under NIV is always necessary for nocturnal monitoring. However, it does not eliminate residual nocturnal hypercapnia in the case of oxygen supplementation into the ventilator. As a result, transcutaneous capnometry may be a very useful tool in such a situation. In a second step, if abnormalities remain, nocturnal polygraphy under NIV should be performed. Assessing data from softwares integrated into the ventilators is helpful for the diagnosis of non intentional leaks and almost events. On the other hand, “conventional” polygraphy remains very important for the diagnosis of complex events.