CHEST Guidelines-A-6-Month-Old-Infant-With-Different-Capnography-Va

A-6-Month-Old-Infant-With-Different-Capnography-Va

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The article details the case of a 6-month-old infant with a history of hypoxic ischemic encephalopathy, referred for evaluation due to snoring. Born at full term via vacuum-assisted delivery due to cardiac decelerations, the infant had a challenging start with low Apgar scores and required intubation shortly after birth. An MRI indicated areas of concern, yet at the time of examination, the infant didn't display problematic breathing when awake, though snoring was observed during sleep. The child, who exhibited hypotonia, lived in a smoke-free environment and was on a special feeding regimen due to minimal spitting.<br /><br />During the diagnostic process, the focus was on capnography values from a polysomnogram (PSG) which revealed differing values between transcutaneous and end-tidal PCO2 monitoring. The transcutaneous measurement was deemed accurate, unlike the fluctuating end-tidal signal which lacked stability due to reasons like mouth-breathing or technical factors. The presence of a plateau in the end-tidal PCO2 waveform is essential for accuracy, as depicted in supplemental figures within the study.<br /><br />For detecting hypoventilation in sleep studies, the American Academy of Sleep Medicine advises the use of arterial, transcutaneous, or end-tidal PCO2, although the former two are preferred in certain scenarios due to their reliability. This case highlights the intricacies of capnography in pediatric sleep studies, emphasizing the necessity for accurate measurement techniques to monitor hypoventilation effectively. This insight is crucial for sleep physicians and technicians involved in interpreting such tests.

Keywords

hypoxic ischemic encephalopathy

infant snoring

polysomnogram

transcutaneous PCO2

end-tidal PCO2

hypoventilation

capnography

pediatric sleep studies

hypotonia

sleep medicine