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Case based discussions
Treatment failure due to use of a ‘ramp’ option on pressure support home ventilators
  1. Jesus Gonzalez-Bermejo1,2,
  2. Claudio Rabec3,
  3. Christophe Perrin4,
  4. Bruno Langevin5,
  5. Jean Louis Pepin6,
  6. Daniel Rodenstein7,
  7. Jean Paul Janssens8
  8. on behalf of the SomnoNIV group
  1. 1UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, UPMC Univ Paris 06, INSERM, Paris, France
  2. 2Assistance publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Pneumologie et Réanimation Médicale, Paris, France
  3. 3Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, Dijon, France
  4. 4Service de Pneumologie, Centre Hospitalier de Cannes, Cannes, France
  5. 5Service de réanimation, Centre Hospitalier, Ales, France
  6. 6Département de Pneumologie et Laboratoire du sommeil, CHRU, Grenoble, France
  7. 7Service de Pneumologie, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium
  8. 8Pulmonary Division, Geneva University Hospitals, Geneva, Switzerland
  1. Correspondence to Dr Jesus Gonzalez-Bermejo, Department of Pneumology and Intensive Care Medicine, Groupe Hospitalier Pitié Salpêtrière, 47-83 boulevard de l'Hôpital, Paris 75651, Cedex 13, France; jesus.gonzalez{at}aphp.fr

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Introduction

Algorithms for monitoring home non-invasive ventilation (NIV) have been recently proposed.1–3 Following this strategy, we detected three cases of transient ineffective ventilation due to the use of a ‘ramp’ option on home pressure support (PS) ventilators. The ‘ramp’ option is a comfort setting initially made available on CPAP devices. This option exists in pressure-cycled ventilators, allowing a progressive increase of expiratory positive airway pressure (EPAP) only. A « ramp » option has also recently been made available for PS: to our knowledge, three home ventilators (Stellar, Resmed, Australia; Prisma, Weinmann, Germany; Dreamstar Duo, Sefam, France) now provide this feature, allowing a stepwise increase of PS from 2 cm H2O to the target PS within 5–45 min.

Case reports

Patients whose data are entered in this work all signed a consent form authorising use of these data for research and teaching purposes.

Three patients previously treated for obstructive sleep apnoea (OSA) with CPAP devices, were switched to NIV because of uncontrolled hypoventilation due to obesity hypoventilation syndrome (OHS) (n=2) or diaphragmatic dysfunction (n=1) (table 1). NIV was introduced using a single circuit pressure-targeted ventilator (Stellar 100, Resmed, Australia) and a calibrated leak, in a ‘Spontaneous/Timed mode’ (assisted PS with a backup respiratory rate). Patients were monitored using a polygraph coupled to …

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