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Recordings were made for 120 min each when awake and asleep, with and without dead space. Transcutaneous blood gas studies were performed on 11 patients with high tetraplegia undergoing pressure-limited pulmonary ventilation with room air. This study sought to confirm whether a dead space of 3 ml.kg-1 could help to provide normocapnic hyperventilation during waking time without causing hypercapnia and hypoxaemia during sleep. Moderate day time hyperventilation from a pressure-limited ventilator is necessary in these patients to avoid hypoxia during sleep due to the variable insufflation leak. Long-term tracheostomy-ventilated patients have better speech with a cuffless tracheostomy tube and a large tidal volume.