A prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population*

Breatnach, Cormac; Conlon, Niamh; Stack, Maria; Healy, Martina; O’Hare, Brendan

doi:10.1097/pcc.0b013e3181b0630f

Cited by 109 publications

(103 citation statements)

References 32 publications

(27 reference statements)

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“…These results are in line with studies in adults that all reported similar synchrony improvement with NAVA (5,11,12,20,21). In the pediatric population, no study has yet quantified the trigger delays and cycling-off delays during conventional ventilation and during NAVA, although two feasibility studies have demonstrated that during NAVA, at least two-thirds of assisted breaths were triggered by the neural signal (17,18). A recent study in a heterogeneous pediatric population showed, similar to our findings, that the inspiratory and expiratory phases of the ventilator match the neural phases of the patient better during NAVA (91% of the time was synchronous) as compared with PCV or pressure-regulated volume-control mode (66% of the time was synchronous) (19).…”

Section: Nava In Infantssupporting

confidence: 75%

“…In studies comparing conventional ventilation to NAVA (and in those studies where the NAVA level was adjusted so that peak pressures were matched), most have reported lower mean airway pressure during NAVA (16,17,19,26). In our study, a trend for lower mean airway pressure was also observed, but it did not reach significance (P = 0.17), probably because of insufficient power (retrospectively calculated power at 28%).…”

Section: Nava In Infantscontrasting

confidence: 47%

“…In the pediatric population, NAVA has been shown to be feasible (17,18) and to be more in phase with the patient's breathing (19). In none of these studies was a specific evaluation performed on the timing differences between the patient and the ventilator on a breath-by-breath basis.…”

mentioning

confidence: 99%

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Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

et al. 2012

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Background: Neurally adjusted ventilatory assist (NaVa) is a mode of ventilation controlled by the electrical activity of the diaphragm (edi). The aim was to evaluate patient-ventilator interaction in infants during NaVa as compared with conventional ventilation. Methods: Infants were successively ventilated with NaVa, pressure control ventilation (PcV), and pressure support ventilation (PsV). edi and ventilator pressure (Pvent) waveforms were compared and their variability was assessed by coefficients of variation. results: Ten patients (mean age 4.3 ± 2.4 mo and weight 5.9 ± 2.2 kg) were studied. In PcV and PsV, 4 ± 4.6% and 6.5 ± 7.7% of the neural efforts failed to trigger the ventilator. This did not occur during NaVa. Trigger delays were shorter with NaVa as compared with PcV and PsV (93 ± 20 ms vs. 193 ± 87 ms and 135 ± 29 ms). During PcV and PsV, the ventilator cycled off before the end of neural inspiration in 12 ± 13% and 21 ± 19% of the breaths (0 ± 0% during NaVa). During PcV and PsV, 24 ± 11% and 25 ± 9% of the neural breath cycle was asynchronous with the ventilator as compared with 11 ± 3% with NaVa. a large variability was observed for edi in all modes, which was transmitted into Pvent during NaVa (coefficient of variation: 24 ± 8%) and not in PcV (coefficient of variation 2 ± 1%) or PsV (2 ± 2%). conclusion: NaVa improves patient-ventilator interaction and delivers adequate ventilation with variable pressure in infants.c onventional modes of mechanical ventilation are clearly limited in their ability to provide synchrony between the patient and the assist delivered, as demonstrated repeatedly in adults (1,2) and more recently in children (3). Patientventilator asynchrony has been associated with poor clinical outcome (1,2,4). Despite the attempt to improve synchrony with "patient-triggered" modes such as pressure control ventilation (PCV) or pressure support ventilation (PSV), 25% of adult patients show more than 10% asynchrony with the ventilator (1,2,5). In pediatric patients, synchrony is particularly difficult to achieve because of the small tidal volumes, high respiratory rates, and weak airway flows and pressures. Ironically, during synchronized intermittent mandatory ventilation, more than half of the patient's breathing cycle is spent in asynchrony (3) with the ventilator.Besides the poor timing between the patient and the ventilator, patient-ventilator asynchrony also includes the inability of the ventilator to respond to patient demand and the natural breath-to-breath variability. Respiratory variability is a sign of a well functioning respiratory system (6). By definition, PCV and PSV deliver fixed levels of assist, thereby offering no possibility to respond to the patient's respiratory demand and variability.Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that delivers assist in time and in proportion to the electrical activity of the diaphragm (Edi) on a breath-by-breath basis (7). Numerous studies have shown that NAVA efficiently unloads the respirat...

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Section: Nava In Infantssupporting

confidence: 75%

Section: Nava In Infantscontrasting

confidence: 47%

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Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

et al. 2012

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“…Breatnach et al 34 compared NAVA to PSV in 16 ventilated infants and children (age range 2 d to 4 years, mean 9.7 months, weight range 2.4 -13.7 kg, mean 6.2 kg). NAVA improved patient-ventilator synchrony and lowered the peak inspiratory pressure, compared to PSV.…”

Section: Neurally Adjusted Ventilatory Assistmentioning

confidence: 99%

Mechanical Ventilation of the Premature Neonate

Brown

DiBlasi

2011

Respir Care

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“…NAVA delivers mechanical assistance in proportion to patient effort, allowing the tailoring of the mechanical support to patient' respiratory characteristics. Several studies 15,[22][23][24][25][26] showed that NAVA is a safe and reliable mode in the pediatric and infant population. It improved synchrony and patient comfort, reduced ventilator drive, and increased breath-tobreath mechanical variability.…”

Section: Discussionmentioning

confidence: 99%

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Conti

Gregoretti²,

Spinazzola

et al. 2015

Respir Care

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BACKGROUND: In adults and children, patient-ventilator synchrony is strongly dependent on both the ventilator settings and interface used in applying positive pressure to the airway. The aim of this bench study was to determine whether different interfaces and ventilator settings may influence patient-ventilator interaction in pediatric models of normal and mixed obstructive and restrictive respiratory conditions. METHODS: A test lung, connected to a pediatric mannequin using different interfaces (endotracheal tube [ETT], face mask, and helmet), was ventilated in pressure support ventilation mode testing 2 ventilator settings (pressurization time [Time press ] 50% /cycling-off flow threshold [Tr exp ] 25% , Time press80% /Tr exp60% ), randomly applied. The test lung was set to simulate one pediatric patient with a healthy respiratory system and another with a mixed obstructive and restricted respiratory condition, at different breathing frequencies (f) (30, 40, and 50 breaths/min). We measured inspiratory trigger delay, pressurization time, expiratory trigger delay, and time of synchrony. RESULTS: At each breathing frequency, the helmet showed the longest inspiratory trigger delay compared with the ETT and face mask. At f 30 , the ETT had a reduced T press . The helmet had the shortest T press in the simulated child with a mixed obstructive and restricted respiratory condition, at f 40 during Time press50% /Tr exp25% and at f 50 during Time press80% /Tr exp60% . In the simulated child with a normal respiratory condition, the ETT presented the shortest T press value at f 50 during Time press80% /Tr exp60% . Concerning the expiratory trigger delay, the helmet showed the best interaction at f 30 , but the worst at f 40 and at f 50 . The helmet showed the shortest time of synchrony during all ventilator settings. CONCLUSIONS: The choice of the interface can influence patient-ventilator synchrony in a pediatric model breathing at increased f, thus making it more difficult to set the ventilator, particularly during noninvasive ventilation. The helmet demonstrated the worst interaction, suggesting that the face mask should be considered as the first choice for delivering noninvasive ventilation in a pediatric model.

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A prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population*

Cited by 109 publications

References 32 publications

Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

Mechanical Ventilation of the Premature Neonate

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

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