Clinical and pulmonary function markers of respiratory exacerbation risk in subjects with quadriplegic cerebral palsy

Andrea Vianello, Elena Carraro, Emanuela Pipitone, Rosario Marchese-Ragona, Giovanna Arcaro, Marco Ferraro, Luciana Paladini, Andrea Martinuzzi

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Although respiratory exacerbations are common in patients with quadriplegic cerebral palsy (CP), little is known about the factors that are related to increased exacerbation risk. This study aimed to identify the clinical and pulmonary function variables signaling risk of exacerbation in this type of patient. METHODS: Thirty-one children and young adults with quadriplegic CP underwent a comprehensive history, physical examination, and pulmonary function test, including arterial blood gas analysis, airway resistance using the interrupter technique, and home overnight SpO2 monitoring. Subjects were divided into 2 groups depending on the number of respiratory exacerbations reported during the year before study entry: frequent exacerbators (ie, ≥ 2 exacerbations) and infrequent exacerbators (ie, <2 exacerbations). RESULTS: The frequent exacerbators were more likely to require hospitalization due to respiratory disorders compared with the infrequent exacerbators (13/14 vs 9/17, P = .02). Respiratory exacerbation was found to be associated with diagnosis of gastroesophageal reflux (adjusted odds ratio of 23.95 for subjects with confirmed diagnosis, P = .02) and higher PaCO2 levels (adjusted odds ratio of 12.60 for every 5-mm Hg increase in PaCO2, P =.05). Subjects with PaCO2 ≥ 35 mm Hg showed an exacerbation odds ratio of 15.2 (95% CI 1.5–152.5, P = .01). CONCLUSIONS: Gastroesophageal reflux and increased PaCO2 can be considered simple, clinically useful markers of increased exacerbation risk in young subjects with quadriplegic CP.

Original languageEnglish
Pages (from-to)1431-1437
Number of pages7
JournalRespiratory Care
Issue number10
Publication statusPublished - Oct 1 2015


  • Arterial blood gases
  • Cerebral palsy
  • Gastroesophageal reflux
  • Pulmonary function test
  • Pulmonary rehabilitation
  • Respiratory exacerbation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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