1077 Home Transcutaneous Carbon Dioxide Tracking for Optimizing Care of Chronic Respiratory Failure

Abstract Introduction Hypoventilation is a key component of respiratory failure, yet both in the clinical sleep laboratory and in the home ventilation care pathway, oximetry is often only measured. Thus, the degree of hypercapnia remains undocumented. Optimal home ventilation should reasonably target both oxygenation and ventilation. The Sleep Respiratory Failure program at the Beth Israel Deaconess, Boston, is a dedicated service managing nocturnal respiratory failure. In collaboration with a home care company, home ventilation tracking program was established. Methods Home testing/tracking of transcutaneous carbon dioxide (TcCO2) using the Sentec device was performed by Regional Home Care, a local DME company during 2021-2023. A respiratory therapist went to the patient’s home and set up the device (pulse oximetry and TcCO2). A report was then sent to the ordering sleep medicine practitioner. TcCO2 tracking was not routine, and ordered only when there was concern for inadequate therapy. Results We included 45 TcCO2 testing (with 34 complete data) from 37 subjects, mean age 61.2 years old (31-84, SD 15.1), mean BMI 33.9 (16.8-58.5, SD 10), female 60% vs male 40% (mean age 63.6 and 57.7, respectively). COPD, OHS and CHF were the key diseases in 8, 5 and 10 subjects and out of those, 9 subjects had 2 combined diseases. 51.5% of subjects were on a ventilator, 30.3% on CPAP, 6% on BiPAP. 9.1% on O2 NC and 3% on room air with 30.3% on both PAP therapy and O2. Overall, average minimal saturation was 77.9% (51-92, SD 11.5) and average % of time with TcCO2 above 50 mmHg (Tover50P) was 30% (0-100, SD 38.2). Male and female subjects demonstrated Tover50P of 41.7% (95% CI 14.2-61.9) and 23.6 (95% CI 8.4-38.9), respectively. Conclusion Home TcCO2 is feasible and informative regarding the state of ventilation in patients with chronic respiratory failure. While oximetry is useful, knowing the actual TcCO2 allows critical decision making, including adjustment of ventilator settings or planning a sleep laboratory titration. It was revealing that residual hypoxia and hypercapnia were very common in this high risk group, despite substantial management effort including a dedicated respiratory failure clinic. Support (if any) Institute for Personalized Sleep Health, Beth Israel Deaconess, Boston