Abstract â–¡ 51

The requirements of the ideal home monitor depend on the reasons for monitoring, which include (1) providing an early warning to carers of near death episodes; and (2) establishing the adequacy of oxygenation or respiratory support. Patients considered for monitoring include (i) those who have suffered recurrent or severe apparent life-threatening events; (ii) very low birth weight infants; (iii) infants with chronic respiratory disease or dependency on respiratory support; and (iv) those with siblings who have died suddenly and unexpectedly. Local decisions must be made as to whether all or some of these infants are routinely offered monitoring, taking into account issues such as compliance with monitoring.

Near death episodes most commonly involve sudden, severe hypoxaemia, with bradycardia, tachycardia or apnoeic pauses occurring less frequently or later in events. Monitoring of oxygenation is therefore most appropriate, and will be required to assess the adequacy of oxygenation, or warm of accidental discontinuation of oxygen supplies. To assess the adequacy of ventilation, monitoring of carbon dioxide is most appropriate.

Users of any monitoring need to be aware of the technical pitfalls and able to respond to monitor alarms. Resuscitation skills may require regular review, and support needs to be available to deal with the stresses associated with home monitoring. The ideal monitor should be light, portable, battery operable, easy to use, have a loud alarm with immediate feedback on the cause of the alarm, no false alarms, and have facilities to record both user compliance and physiological variables. The latter will help in management of monitor alarms and abuse.