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Comparison of transthoracic impedance/heart rate monitoring and pulse oximetry for patients using diaphragm pacemakers
Author(s) -
Marzocchi Mirella,
Brouillette Robert T.,
WeeseMayer Debra E.,
Morrow Anna S.,
Conway Linda P.
Publication year - 1990
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.1950080109
Subject(s) - medicine , pulse oximetry , cardiology , hypoventilation , airway obstruction , bradycardia , anesthesia , heart rate , diaphragmatic breathing , respiratory rate , airway , diaphragm (acoustics) , capnography , respiratory system , blood pressure , physics , alternative medicine , pathology , loudspeaker , acoustics
Patients using diaphragm pacemakers have several respiratory‐related problems placing them at high risk for death during sleep, including central hypoventilation, abnormal arousal responses, upper airway and/or tracheostomy obstruction, and, in the case of high quadriplegia, lack of motor response to airway obstruction. The recent death from airway obstruction of a patient using diaphragm pacemakers prompted us to re‐evaluate both the need for home monitoring and the type of monitor to prescribe. We compared the performance of a transthoracic impedance/heart rate (TI/HR) monitor with that of a pulse oximeter in six patients with central hypoventilation syndrome whose treatment included diaphragm pacing. Polygraphic recordings of airflow, ECG, Sa 0 2 , transthoracic impedance, heart rate, and breath detection were obtained during brief tracheostomy occlusion during patient sleep. Although none of 13 occlusions was detected by the TI/HR monitor, the pulse oximeter identified 13 of 13 occlusions. Three reasons for TI/HR monitor failure included 1) the breath detection circuit consistently registered a breath with each obstructed, paced diaphragmatic contraction; 2) bradycardia did not occur during any airway occlusion; and 3) pacemaker stimuli were misinterpreted as additional heart beats, increasing apparent heart rate. Thus, pulse oximetry, but not TI/HR monitoring, can detect life‐threatening airway obstruction in children using diaphragm pacemakers. Pediatr Pulmonol 1990; 8:29‐32.