54Non-invasive positive pressure ventilation (NIPPV) has become the accepted standard of care for the initial management of respiratory insufficiency in amyotrophic lateral sclerosis (ALS) 1,2 . A series of prospective studies have shown that when tolerated for greater than four hours per day, NIPPV therapy prolongs survival, increases quality of life and reduces decline in pulmonary function [3][4][5][6][7] . In addition, a recent randomized controlled trial has supported NIPPV's survival and quality of life benefit in a subset of ALS patients with good bulbar function 8 . Nevertheless, considerable variability in the prevalence of NIPPV use has been documented in the international ALS patient population. A survey of 265 British neurologists reported that approximately 2.6 -3.5% of patients were utilizing NIPPV, with 30% of all referrals coming from three physicians 9 . In addition, a questionnaire completed by 110 ABSTRACT: Objective: The purpose of this study was to evaluate Canadian amyotrophic lateral sclerosis (ALS) centres with respect to: 1) the prevalence of Non-invasive positive pressure ventilation (NIPPV) and invasive mechanical ventilation via tracheostomy (TV) utilization, 2) the approach to NIPPV use, focusing upon the currently employed initiation criteria and 3) the barriers influencing NIPPV administration. Methods: A descriptive survey research design aimed to obtain quantitative data and open-ended responses from an active physician at each of the 15 multidisciplinary Canadian ALS centres. Results: The principal findings of this study were: 1) NIPPV and TV are used in 18.3% and 1.5% of patients at Canadian ALS centres, respectively, 2) symptoms of respiratory insufficiency, namely orthopnea (clinical significance rated at 9.00/10 ± 1.48), dyspnea (8.27 ± 1.95) and morning headache (7.55 ± 1.21) are the most significant indicators for NIPPV initiation, 3) the primary barriers to NIPPV utilization are patient intolerance (70% of centres) and inaccessibility of respirologists and ventilation technologists (50% of centres). Conclusions: Variability in NIPPV use has an impact upon the management of Canadian ALS patients. The establishment of more definitive NIPPV initiation criteria, emphasizing respiratory symptoms, and the attenuation of barriers to NIPPV use should be targeted so as to ensure optimal care for all ALS patients.RÉSUMÉ: La NIPPV : prévalence, approche et freins à son utilisation dans les centres canadiens de traitement de la SLA. Objectif : Le but de cette étude était d'examiner dans les centres canadiens de traitement de la SLA : 1) la prévalence de NIPPV (ventilation non invasive en pression positive) et de l'utilisation de la ventilation mécanique avec trachéotomie (VT); 2) l'approche à l'utilisation de NIPPV ciblant les critères utilisés actuellement pour la commencer et 3) les freins à son utilisation. Méthodes : Nous avons utilisé un plan d'enquête descriptive dont le but était d'obtenir des données quantitatives et des réponses ouvertes des médecins pratiquant dans chacun d...