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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.
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 …