For NPPV, we used respirators specifically designed for chronic domiciliary nocturnal ventilation, a technique with which we are accustomed (ie, Bennett Companion 2000, Kontron ABT 4100, or Draeger EV 800). All of these ventilators were used in the same way: assist-control mode; without PEEP; and breathing frequency, tidal volume, inspiratory:expiratory time ratio, and “trigger” function chosen according to the patients comfort and arterial blood gas levels, after trial-and-error assays. The FIo2 was adjusted according to arterial blood gas levels.
To connect the patient with the respirator, we start with standard nasal masks designed for longterm domiliciary nasal ventilation adjusted to the size of the patients face (Respironics R nasal masks; Medicaid Ltd, West Sussex, UK); and when the patient was accustomed to the technique (ie, the following day), we molded a personalized nasal mask made of a specially designed paste (SEFAM, Soci6t£ d’Etude et Fabrication d’Appareillage Medical, F 54500; Vandoeuvre-les-Nancy, France). All patients were equipped with a nasogastric tube under continuous suction and carefully fitted with the nasal mask to avoid pain. None of our patients vomited or suffered from bronchial aspiration.