Comparison of transthoracic impedance/heart rate monitoring and pulse oximetry for patients using diaphragm pacemakers
Identifieur interne : 005C01 ( Istex/Corpus ); précédent : 005C00; suivant : 005C02Comparison of transthoracic impedance/heart rate monitoring and pulse oximetry for patients using diaphragm pacemakers
Auteurs : Mirella Marzocchi ; Robert T. Brouillette ; Debra E. Weese-Mayer ; Anna S. Morrow ; Linda P. ConwaySource :
- Pediatric Pulmonology [ 8755-6863 ] ; 1990.
English descriptors
- KwdEn :
- Absent airflow, Additional heart, Airflow, Airway, Airway obstruction, Airway occlusion, Airway occlusions, Apnea, Asphyxia, Bradycardia, Bradycardic response, Breath detection, Breath detection circuit, Bronchopulmonary dysplasia, Brouillette, Case report, Central hypoventilation, Central hypoventilation syndrome, Diaphragm pacemakers, Diaphragmatic, Diaphragmatic contractions, Heart rate, Heart rate detection circuit, High quadriplegia, Home monitoring, Hypoventilation, Hypoxemia, Impedance, Obstruction, Obstructive apnea, Occlusion, Oximeter, Oximetry, Pacemaker, Pacemaker stimuli, Pediatr, Pediatric, Pediatrics, Phrenic, Phrenic nerve, Polygraph, Polygraphic recordings, Pulse oximeter, Pulse oximetry, Quadriplegia, Recent death, Respiratory control, Respiratory inductive plethysmography, Thoracic impedance, Tracheostomy, Tracheostomy occlusion, Transthoracic, Transthoracic impedance, Transthoracic rate, Transthoracic rate monitoring, Upper airway, Upper airway obstruction, Ventilatory.
- Teeft :
- Absent airflow, Additional heart, Airflow, Airway, Airway obstruction, Airway occlusion, Airway occlusions, Apnea, Asphyxia, Bradycardia, Bradycardic response, Breath detection, Breath detection circuit, Bronchopulmonary dysplasia, Brouillette, Case report, Central hypoventilation, Central hypoventilation syndrome, Diaphragm pacemakers, Diaphragmatic, Diaphragmatic contractions, Heart rate, Heart rate detection circuit, High quadriplegia, Home monitoring, Hypoventilation, Hypoxemia, Impedance, Obstruction, Obstructive apnea, Occlusion, Oximeter, Oximetry, Pacemaker, Pacemaker stimuli, Pediatr, Pediatric, Pediatrics, Phrenic, Phrenic nerve, Polygraph, Polygraphic recordings, Pulse oximeter, Pulse oximetry, Quadriplegia, Recent death, Respiratory control, Respiratory inductive plethysmography, Thoracic impedance, Tracheostomy, Tracheostomy occlusion, Transthoracic, Transthoracic impedance, Transthoracic rate, Transthoracic rate monitoring, Upper airway, Upper airway obstruction, Ventilatory.
Abstract
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, Sa02, 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.
Url:
DOI: 10.1002/ppul.1950080109
Links to Exploration step
ISTEX:B8AA5C2699B767D24B499F0A095F2726F6E613D8Le document en format XML
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Conway</name><affiliation><mods:affiliation>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Pediatric Pulmonology</title><title level="j" type="alt">PEDIATRIC PULMONOLOGY</title><idno type="ISSN">8755-6863</idno><idno type="eISSN">1099-0496</idno><imprint><biblScope unit="vol">8</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="29">29</biblScope><biblScope unit="page" to="32">32</biblScope><biblScope unit="page-count">4</biblScope><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>New York</pubPlace><date type="published" when="1990">1990</date></imprint><idno type="ISSN">8755-6863</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">8755-6863</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Absent airflow</term><term>Additional heart</term><term>Airflow</term><term>Airway</term><term>Airway obstruction</term><term>Airway occlusion</term><term>Airway occlusions</term><term>Apnea</term><term>Asphyxia</term><term>Bradycardia</term><term>Bradycardic response</term><term>Breath detection</term><term>Breath detection circuit</term><term>Bronchopulmonary dysplasia</term><term>Brouillette</term><term>Case report</term><term>Central hypoventilation</term><term>Central hypoventilation syndrome</term><term>Diaphragm pacemakers</term><term>Diaphragmatic</term><term>Diaphragmatic contractions</term><term>Heart rate</term><term>Heart rate detection circuit</term><term>High quadriplegia</term><term>Home monitoring</term><term>Hypoventilation</term><term>Hypoxemia</term><term>Impedance</term><term>Obstruction</term><term>Obstructive apnea</term><term>Occlusion</term><term>Oximeter</term><term>Oximetry</term><term>Pacemaker</term><term>Pacemaker stimuli</term><term>Pediatr</term><term>Pediatric</term><term>Pediatrics</term><term>Phrenic</term><term>Phrenic nerve</term><term>Polygraph</term><term>Polygraphic recordings</term><term>Pulse oximeter</term><term>Pulse oximetry</term><term>Quadriplegia</term><term>Recent death</term><term>Respiratory control</term><term>Respiratory inductive plethysmography</term><term>Thoracic impedance</term><term>Tracheostomy</term><term>Tracheostomy occlusion</term><term>Transthoracic</term><term>Transthoracic impedance</term><term>Transthoracic rate</term><term>Transthoracic rate monitoring</term><term>Upper airway</term><term>Upper airway obstruction</term><term>Ventilatory</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Absent airflow</term><term>Additional heart</term><term>Airflow</term><term>Airway</term><term>Airway obstruction</term><term>Airway occlusion</term><term>Airway occlusions</term><term>Apnea</term><term>Asphyxia</term><term>Bradycardia</term><term>Bradycardic response</term><term>Breath detection</term><term>Breath detection circuit</term><term>Bronchopulmonary dysplasia</term><term>Brouillette</term><term>Case report</term><term>Central hypoventilation</term><term>Central hypoventilation syndrome</term><term>Diaphragm pacemakers</term><term>Diaphragmatic</term><term>Diaphragmatic contractions</term><term>Heart rate</term><term>Heart rate detection circuit</term><term>High quadriplegia</term><term>Home monitoring</term><term>Hypoventilation</term><term>Hypoxemia</term><term>Impedance</term><term>Obstruction</term><term>Obstructive apnea</term><term>Occlusion</term><term>Oximeter</term><term>Oximetry</term><term>Pacemaker</term><term>Pacemaker stimuli</term><term>Pediatr</term><term>Pediatric</term><term>Pediatrics</term><term>Phrenic</term><term>Phrenic nerve</term><term>Polygraph</term><term>Polygraphic recordings</term><term>Pulse oximeter</term><term>Pulse oximetry</term><term>Quadriplegia</term><term>Recent death</term><term>Respiratory control</term><term>Respiratory inductive plethysmography</term><term>Thoracic impedance</term><term>Tracheostomy</term><term>Tracheostomy occlusion</term><term>Transthoracic</term><term>Transthoracic impedance</term><term>Transthoracic rate</term><term>Transthoracic rate monitoring</term><term>Upper airway</term><term>Upper airway obstruction</term><term>Ventilatory</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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, Sa02, 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.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>airway</json:string><json:string>tracheostomy</json:string><json:string>oximetry</json:string><json:string>obstruction</json:string><json:string>apnea</json:string><json:string>pulse oximetry</json:string><json:string>airway obstruction</json:string><json:string>hypoventilation</json:string><json:string>brouillette</json:string><json:string>ventilatory</json:string><json:string>transthoracic</json:string><json:string>oximeter</json:string><json:string>impedance</json:string><json:string>diaphragmatic</json:string><json:string>phrenic</json:string><json:string>quadriplegia</json:string><json:string>pacemaker</json:string><json:string>pediatrics</json:string><json:string>hypoxemia</json:string><json:string>tracheostomy occlusion</json:string><json:string>diaphragm pacemakers</json:string><json:string>pediatr</json:string><json:string>pulse oximeter</json:string><json:string>occlusion</json:string><json:string>pediatric</json:string><json:string>polygraph</json:string><json:string>high quadriplegia</json:string><json:string>asphyxia</json:string><json:string>breath detection circuit</json:string><json:string>heart rate</json:string><json:string>bradycardia</json:string><json:string>home monitoring</json:string><json:string>airway occlusion</json:string><json:string>bradycardic response</json:string><json:string>central hypoventilation</json:string><json:string>heart rate detection circuit</json:string><json:string>phrenic nerve</json:string><json:string>absent airflow</json:string><json:string>upper airway obstruction</json:string><json:string>polygraphic recordings</json:string><json:string>transthoracic rate</json:string><json:string>case report</json:string><json:string>respiratory control</json:string><json:string>diaphragmatic contractions</json:string><json:string>pacemaker stimuli</json:string><json:string>recent death</json:string><json:string>airway occlusions</json:string><json:string>central hypoventilation syndrome</json:string><json:string>transthoracic impedance</json:string><json:string>breath detection</json:string><json:string>thoracic impedance</json:string><json:string>additional heart</json:string><json:string>upper airway</json:string><json:string>transthoracic rate monitoring</json:string><json:string>obstructive apnea</json:string><json:string>respiratory inductive plethysmography</json:string><json:string>bronchopulmonary dysplasia</json:string><json:string>airflow</json:string></teeft></keywords><author><json:item><name>Mirella Marzocchi MD</name><affiliations><json:string>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois</json:string></affiliations></json:item><json:item><name>Dr. Robert T. Brouillette MD</name><affiliations><json:string>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois</json:string><json:string>Correspondence address: The Montreal Children's Hospital, Division of Newborn Medicine, 2300 Rue Tupper, Room C‐920, Montreal, Quebec, Canada H3H 1P3</json:string></affiliations></json:item><json:item><name>Debra E. Weese‐Mayer MD</name><affiliations><json:string>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois</json:string></affiliations></json:item><json:item><name>Anna S. Morrow CRRT</name><affiliations><json:string>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois</json:string></affiliations></json:item><json:item><name>Linda P. Conway CRRT</name><affiliations><json:string>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>phrenic nerve pacing</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>oximetry</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>polygraphic recordings</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>home monitoring</value></json:item></subject><articleId><json:string>PPUL1950080109</json:string></articleId><arkIstex>ark:/67375/WNG-6M0H127X-G</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>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, Sa02, 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. 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xml:lang="en">Comparison of transthoracic impedance/heart rate monitoring and pulse oximetry for patients using diaphragm pacemakers</title><title level="a" type="short" xml:lang="en">Monitoring Patients Using Diaphragm Pacemakers</title><author xml:id="author-0000"><persName><forename type="first">Mirella</forename><surname>Marzocchi</surname><roleName type="degree">MD</roleName></persName><affiliation>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois<address><country key="US"></country></address></affiliation></author><author xml:id="author-0001" role="corresp"><persName><addName>Dr.</addName><forename type="first">Robert T.</forename><surname>Brouillette</surname><roleName type="degree">MD</roleName></persName><affiliation>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois<address><country key="US"></country></address></affiliation><affiliation>The Montreal Children's Hospital, Division of Newborn Medicine, 2300 Rue Tupper, Room C‐920, Montreal, Quebec, Canada H3H 1P3</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Debra E.</forename><surname>Weese‐Mayer</surname><roleName type="degree">MD</roleName></persName><affiliation>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois<address><country key="US"></country></address></affiliation></author><author xml:id="author-0003"><persName><forename type="first">Anna S.</forename><surname>Morrow</surname><roleName type="degree">CRRT</roleName></persName><affiliation>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois<address><country key="US"></country></address></affiliation></author><author xml:id="author-0004"><persName><forename type="first">Linda P.</forename><surname>Conway</surname><roleName type="degree">CRRT</roleName></persName><affiliation>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois<address><country key="US"></country></address></affiliation></author><idno type="istex">B8AA5C2699B767D24B499F0A095F2726F6E613D8</idno><idno type="ark">ark:/67375/WNG-6M0H127X-G</idno><idno type="DOI">10.1002/ppul.1950080109</idno><idno type="unit">PPUL1950080109</idno><idno type="toTypesetVersion">file:PPUL.PPUL1950080109.pdf</idno></analytic><monogr><title level="j" type="main">Pediatric Pulmonology</title><title level="j" type="alt">PEDIATRIC PULMONOLOGY</title><idno type="pISSN">8755-6863</idno><idno type="eISSN">1099-0496</idno><idno type="book-DOI">10.1002/(ISSN)1099-0496</idno><idno type="book-part-DOI">10.1002/ppul.v8:1</idno><idno type="product">PPUL</idno><imprint><biblScope unit="vol">8</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="29">29</biblScope><biblScope unit="page" to="32">32</biblScope><biblScope unit="page-count">4</biblScope><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>New York</pubPlace><date type="published" when="1990"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><head>Abstract</head><p>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<hi rend="subscript">0</hi><hi rend="subscript">2</hi>, 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.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="kwd1">phrenic nerve pacing</term><term xml:id="kwd2">oximetry</term><term xml:id="kwd3">polygraphic recordings</term><term xml:id="kwd4">home monitoring</term></keywords><keywords rend="articleCategory"><term>Original Article</term></keywords><keywords rend="tocHeading1"><term>Original Articles</term></keywords></textClass><langUsage><language ident="en"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/B8AA5C2699B767D24B499F0A095F2726F6E613D8/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>New York</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1099-0496</doi><issn type="print">8755-6863</issn><issn type="electronic">1099-0496</issn><idGroup><id type="product" value="PPUL"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="PEDIATRIC PULMONOLOGY">Pediatric Pulmonology</title><title type="short">Pediatr. 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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<sub>0</sub><sub>2</sub>, 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.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Comparison of transthoracic impedance/heart rate monitoring and pulse oximetry for patients using diaphragm pacemakers</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Monitoring Patients Using Diaphragm Pacemakers</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Comparison of transthoracic impedance/heart rate monitoring and pulse oximetry for patients using diaphragm pacemakers</title></titleInfo><name type="personal"><namePart type="given">Mirella</namePart><namePart type="family">Marzocchi</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="termsOfAddress">Dr.</namePart><namePart type="given">Robert T.</namePart><namePart type="family">Brouillette</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois</affiliation><affiliation>Correspondence address: The Montreal Children's Hospital, Division of Newborn Medicine, 2300 Rue Tupper, Room C‐920, Montreal, Quebec, Canada H3H 1P3</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Debra E.</namePart><namePart type="family">Weese‐Mayer</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anna S.</namePart><namePart type="family">Morrow</namePart><namePart type="termsOfAddress">CRRT</namePart><affiliation>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Linda P.</namePart><namePart type="family">Conway</namePart><namePart type="termsOfAddress">CRRT</namePart><affiliation>Department of Pediatrics, Northwestern University Medical School, The Children's Memorial Hospital Chicago, Illinois</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">New York</placeTerm></place><dateIssued encoding="w3cdtf">1990</dateIssued><dateCaptured encoding="w3cdtf">1989-05-17</dateCaptured><copyrightDate encoding="w3cdtf">1990</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><extent unit="figures">1</extent><extent unit="tables">0</extent><extent unit="references">18</extent></physicalDescription><abstract lang="en">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, Sa02, 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.</abstract><note type="funding">Children's Research Guild</note><note type="funding">Chicago Lung Association</note><subject lang="en"><genre>keywords</genre><topic>phrenic nerve pacing</topic><topic>oximetry</topic><topic>polygraphic recordings</topic><topic>home monitoring</topic></subject><relatedItem type="host"><titleInfo><title>Pediatric Pulmonology</title></titleInfo><titleInfo type="abbreviated"><title>Pediatr. 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