Ambulatory Adaptation to Non-Invasive Mechanical Ventilation

Inclusion criteria

• Age between 18 and 75
• Chronic respiratory insufficiency secondary to neuromuscular disease or thoracic cage alterations with indication of non-invasive mechanical ventilation (presence of fatigue, dyspnea, morning headache, etc) plus one of the following criteria):

• PaCO2 > 45 mmHg
• Night time oxygen saturation < 88% at least for 5 consecutive minutes
• In neuromuscular diseases, PIM < 60 cmH2O or FVC < 50% of theoretical.
• Stable disease.
• Airway access through nasal mask.
• Ability to provide written informed consent.
• Ability to attend the visits

Exclusion criteria

• Contraindications for mechanical ventilation:

• Patient with terminal disease or vegetative state
• Lack of motivation of the patient
• Lack of family or social support
• Patients clinically unstable
• Agitation or lack of co-operation
• Depression.
• Patients with acute symptoms requiring hospital admission.
• Need for airway access through tracheostomy, face mask or mouth piece.
• Relevant comorbidity (ie. heart failure, diabetes non controlled, infections, malignancies, etc.) leading to difficulties in adaptation to ventilation.
• Use (for 7 days or more) of CNS depressors(benzodiazepines, antihistamines H1, tricyclic antidepressants , antiepileptic or antipsychotic drugs ) in the 30-day period prior to inclusion, or expected need for such drugs during the study.
• Lack of understanding of the study procedures.