A Fatal Complication of Noninvasive Ventilation

To the Editor: Noninvasive positive-pressure ventilation is widely used in patients with chronic respiratory failure due to neuromuscular diseases such as amyotrophic lateral sclerosis.1 Noninvasive positive-pressure ventilation can be used intermittently, the equipment is portable, and ventilation does not interfere with eating and speaking. It is considered safe, and most problems that occur are related to the fit of the mask and the risk of aspiration pneumonitis.2 We describe a complication we have not previously seen reported. The patient was a previously healthy 53-year-old man with amyotrophic lateral sclerosis who was started on nocturnal noninvasive positive-pressure ventilation (inspiratory pressure, 10 . . .