Is positive expiratory pressure (PEEP) during noninvasive ventilation (NIV) useful in patients with amyotrophic lateral sclerosis (ALS)?

Background: Variable effects of PEEP application during nocturnal NIV have been reported in neuromuscular subjects. However, no data are available for samples including only ALS patients. Aim: To evaluate nocturnal gas exchanges, sleep quality, patient-ventilator asynchronies and air leaks in stable ALS patients naïve to ventilatory treatment during NIV application with or without PEEP in addition to inspiratory pressure support. Methods: Seventeen ALS patients, age 64.6±6.8 underwent two nocturnal polysomnographies during NIV with no PEEP (PEEP0) or with 4 cm H20 PEEP (PEEP4), in random order. Results: No differences in nocturnal blood gases between nights were observed. With PEEP0, a longer N3 duration, fewer autotriggerings and air leaks were recorded Conclusion: In stable ALS patients, PEEP application did not improve nocturnal blood exchanges, and was associated with worse sleep and NIV quality.