A randomized clinical trial of neurally adjusted ventilatory assist versus conventional weaning mode in patients with COPD and prolonged mechanical ventilation

Abstract

BackgroundPatient-ventilator asynchrony is a common problem in mechanically ventilated patients; the problem is especially obvious in COPD. Neutrally adjusted ventilatory assist (NAVA) can improve patient-ventilator asynchrony; however, the effect in COPD patients with prolonged mechanical ventilation is still unknown. The goals of this study are to evaluate the effect of NAVA and conventional weaning mode in patients with COPD during prolonged mechanical ventilation.MethodsThe study enrolled a total of 33 COPD patients with ventilator dependency for more than 21 days in the weaning center. A diaphragm electrical activity (Edi) catheter was inserted in patients within 24 hours after admission to the respiratory care center, and patients were randomly allocated to NAVA or conventional group. A spontaneous breathing trial was performed every 24 hours. The results correlated with the clinical parameters.ResultsThere were significantly higher asynchrony incidence rates in the whole group after using Edi catheter (before vs post-Edi catheter insertion =60.6% vs 87.9%, P<0.001). Asynchrony index: before vs post-Edi catheter insertion =7.4%±8.5% vs 13.2%±13.5%, P<0.01. Asynchrony incidence: NAVA vs conventional =0% vs 84.2%, P<0.001. Asynchrony index: NAVA vs conventional =0 vs 11.9±11.2 (breath %), P<0.001. The most common asynchrony events were ineffective trigger and delayed trigger.ConclusionCompared to conventional mode, NAVA mode can significantly enhance respiratory monitoring and improve patient-ventilator interaction in COPD patients with prolonged mechanical ventilation in respiratory care center.

Neurally Adjusted Ventilatory Assist (NAVA) or Pressure Support Ventilation (PSV) during spontaneous breathing trials in critically ill patients: a crossover trial

“…However, there are no studies describing the breathing pattern and performance of NAVA during SBTs. Under current treatment paradigms, when deemed ready to undergo an SBT, patients ventilated with NAVA need to perform the SBT either in a T-tube, which provides less objective monitoring of respiratory parameters, or in PSV, which may increase the occurrence of patient-ventilator asynchrony [ 20 – 22 ]. Therefore, we designed a pilot trial to assess the feasibility of using NAVA during SBTs, to estimate the rate of success in the SBT on NAVA and to compare the breathing pattern and patient-ventilator asynchrony of NAVA with PSV during SBTs.…”

Non Invasive Ventilation in Acute Hypercapnic Respiratory Failure

“…Modes of ventilation which in theory should provide more effective NIV 47,48 have failed to establish a role for themselves in everyday practice, though there is a minor resurgence of interest in neutrally adjusted ventilatory assistance (NAVA) 49,50 . High flow nasal oxygen (HFNO) appears to have a role in hypoxaemic respiratory failure 51 ; a higher F I O 2 can be delivered more consistently and comfortably but it remains to be seen whether the small physiological effects, dead space wash out and a low level of PEEP and better humidification are sufficient to have an important effect in AHRF.…”

Prolongiertes Weaning

“…Eine längerfristige vollständige Entlastung führt zu einer Atrophie der Atemmuskulatur [252] [290,291]. In einer kürzlich publizierten prospektiven randomisierten Studie [292] wurde bei 33 COPD-Patienten im prolongierten Weaning gezeigt, dass alleine der Einsatz des Zwerchfellmonitorings zu einer signifikanten Optimierung der konventionellen Beatmung führt und dass 69 % eine verbesserte Synchronisation, Reduktion der Atemarbeit und erhöhten Komfort nach Umstellung auf NAVA hatten.…”