title: Randomized cross-over trial of ventilator modes during non-invasive ventilation titration in amyotrophic lateral sclerosis.
abstract: 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).
  
  
  
  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.
  
  
  
  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 < 0.05) and respiratory events (obstructive: 8.9 (1.2-18.3)/h sleep vs 1.8 (0.3-4.9)/h sleep and central: 2.6 (0.4-14.1)/h sleep vs 0.2 (0.0-1.1)/h sleep for S and ST mode, respectively, both P < 0.01). No differences in sleep architecture were found. Ineffective efforts and respiratory events were more frequently present in S mode. Nevertheless, four patients were discharged on S mode as these patients showed clinically better results for sleep architecture and PVA during the night on S mode.
  
  
  
  ST mode shows better results in gas exchange, respiratory events and PVA. Nevertheless, accurate NIV titration remains necessary as some patients show equal or better results when using the S mode.
authors.affiliation: Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, Leuven, Belgium.|Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Bart
authors.identifier: 0000-0003-3882-661X
authors.initials: B
authors.lastname: Vrijsen
authors.affiliation: Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, Leuven, Belgium.|Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Bertien
authors.initials: B
authors.lastname: Buyse
authors.affiliation: Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, Leuven, Belgium.|Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Catharina
authors.initials: C
authors.lastname: Belge
authors.affiliation: Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, Leuven, Belgium.|Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Goele
authors.initials: G
authors.lastname: Vanpee
authors.affiliation: Department of Neurology, University Hospitals Leuven, Leuven, Belgium.|Department of Neurosciences, KU Leuven - University of Leuven, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium.
authors.forename: Philip
authors.initials: P
authors.lastname: Van Damme
authors.affiliation: Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, Leuven, Belgium.|Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Dries
authors.initials: D
authors.lastname: Testelmans
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D001785:Blood Gas Monitoring, Transcutaneous; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods*; D010092:Oximetry; D017286:Polysomnography; D011788:Quality of Life; D012890:Sleep / Q000502:physiology*
keywords: amyotrophic lateral sclerosis; non-invasive ventilation; polysomnography; pulmonary gas exchange; sleep