Randomized cross‐over trial of ventilator modes during non‐invasive ventilation titration in amyotrophic lateral sclerosis

ABSTRACT Background and objective Non‐invasive ventilation (NIV) improves survival, quality of life and sleep in patients with amyotrophic lateral sclerosis (ALS). Nevertheless, NIV titration is conducted in different ways. We aim to provide more insight into NIV titration by comparing the effects of a spontaneous (S) and spontaneous‐timed (ST) modes on gas exchange, sleep architecture and patient‐ventilator asynchronies (PVAs). Methods After an initial night of NIV titration, patients were randomized to S or ST mode in a cross‐over design. NIV was titrated using polysomnography, oximetry (oxygen saturation, SpO2 %) and transcutaneous carbon dioxide (PtcCO2 ) measurement. PVAs were analysed breath‐by‐breath. Results Thirteen patients were analysed after inclusion. ST mode showed better results in gas exchange (minimal SpO2 %: 83 (80–89)% vs 87 (84–89)%; oxygen desaturation index: 15 (5–28)/h sleep vs 7 (3–9)/h sleep; PtcCO2 >55 mm Hg: 20 (0–59)% vs 0 (0–27)% total sleep time for S and ST mode, respectively, all P