Noninvasive ventilation protocol Every ventilator adjustment in this study was made according to a simple algorithm, developed within a multidisciplinary working group involving ICU physicians, nurses and respiratory therapists, and implemented in our unit since 2008 (1, 2). This algorithm aimed at empowering nurses to adjust the ventilator settings following a rational decision algorithm. Its goals are the followings: to improve patient's tolerance at the onset of the NIV session, to adjust

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... pressure support level in order to target a desired expired tidal volume range, to use the lowest efficient inspiratory and expiratory pressures and minimize the deleterious effects of leaks (3), and to allow re-adjustments of the settings during the NIV session. Its main principles are the followings (1, 2):  The physician provides on a daily prescription form: o The minimal number of NIV sessions per day. o The minimal total duration of NIV per day. o The expired tidal volume (Vte) target range. o The minimal pressure support level (PSL) allowed. o The pulse oximetry (SpO2) target range. o The positive end expiratory pressure (PEEP) level.