Comparison of extubation success using noninvasive positive pressure ventilation (NIPPV) versus noninvasive neurally adjusted ventilatory assist (NI-NAVA)

Makker, Kartikeya; Cortez, Josef; Jha, Kanishk; Shah, Sanket D.; Nandula, Padma; Lowrie, David; Smotherman, Carmen; Gautam, Shiva; Hudak, Mark L.

doi:10.1038/s41372-019-0578-4

Cited by 28 publications

(41 citation statements)

References 35 publications

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“…In premature infants synchronized NIPPV was associated with greater decrease in the work of breathing (WOB) than nCPAP alone 13 . NIV-NAVA proved more efficacious than both non-synchronized NIPPV and nCPAP after extubation 14 , 15 . The combination of heliox and NIV-NAVA may promote NIV success, providing a synergistic approach to premature infants with respiratory failure.…”

Section: Introductionmentioning

confidence: 94%

Effects of heliox and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants

Neumann-Klimasińska

Merritt

Beck

et al. 2021

Sci Rep

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Due to its unique properties, helium–oxygen (heliox) mixtures may provide benefits during non-invasive ventilation, however, knowledge regarding the effects of such therapy in premature infants is limited. This is the first report of heliox non-invasive neurally adjusted ventilatory assist (NIV-NAVA) ventilation applied in neonates born ≤ 32 weeks gestational age. After baseline NIV-NAVA ventilation with a standard mixture of air and oxygen, heliox was introduced for 3 h, followed by 3 h of air-oxygen. Heart rate, peripheral capillary oxygen saturation, cerebral oxygenation, electrical activity of the diaphragm (Edi) and selected ventilatory parameters (e.g., respiratory rate, peak inspiratory pressure) were continuously monitored. We found that application of heliox NIV-NAVA in preterm infants was feasible and associated with a prompt and significant decrease of Edi suggesting reduced respiratory effort, while all other parameters were stable throughout the study, and had similar values during heliox and air-oxygen ventilation. This therapy may potentially enhance the efficacy of non-invasive respiratory support in preterm neonates and reduce the number of infants progressing to ventilatory failure.

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Section: Introductionmentioning

confidence: 94%

Effects of heliox and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants

Neumann-Klimasińska

Merritt

Beck

et al. 2021

Sci Rep

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“…A decreased neural respiratory effort was observed during NIV-NAVA and NIPPV when compared to NCPAP. The higher MAP provided during NIPPV (median = 8.2) and NIV-NAVA (median = 9.3) proportionally offloaded the diaphragm, taking some of the work of breathing away from the infant as previously described 8,12,26 . Interestingly, the NIPPV mode on the Servo-i ventilator has flow-synchronization using an internal sensor, which this study has demonstrated to be largely ineffective.…”

Section: Diaphragmatic Activitymentioning

confidence: 68%

“…The apnea detection time used to trigger backup ventilation was of 10s and a shorter period may have been more appropriate in these patients 35 . While some small randomized controlled trials 8,36 and retrospective studies [37][38][39] reported reduced respiratory failure rates with NIV-NAVA, there is a lack of good evidence to determine its superiority over other modes of noninvasive support 40 . Thus, until larger randomized trials are conducted, some caution should be exercised when integrating NIV-NAVA into the care of extremely preterm infants.…”

Section: Respiratory Variabilitymentioning

confidence: 99%

“…Non-invasive neurally adjusted ventilatory assist (NIV-NAVA) is a mode of ventilation that uses the diaphragm electrical activity (Edi) signal to deliver synchronized mechanical inflations, thus improving patientventilator interaction 7 . NIV-NAVA is not affected by system leaks, provides continuous monitoring of respiratory pattern and drive, and has been successfully applied after extubation by some centers 8 . Analysis of cardiorespiratory behavior, including heart rate variability (HRV), diaphragmatic activity as surrogate of respiratory effort, and respiratory variability (RV), has been valuable in providing insight on the individualized physiological impact of different systems [9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

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Cardiorespiratory effects of NIV-NAVA, NIPPV, and NCPAP shortly after extubation in extremely preterm infants: a randomized crossover trial

Latremouille

Bhuller

Shalish

et al. 2021

Preprint

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Objective: Investigate the cardiorespiratory effects of non-invasive neurally adjusted ventilatory assist (NIV-NAVA), non-synchronized nasal intermittent positive pressure ventilation (NIPPV), and nasal continuous positive airway pressure (NCPAP) during the critical period shortly after extubation. Hypothesis: Levels of non-invasive pressure support provided and/or presence of synchronization can affect cardiorespiratory parameters. Study design: Randomized crossover trial. Patient-subject selection: Infants with birth weight (BW) ≤ 1250g undergoing their first planned extubation were randomly assigned to all 3 modes following extubation. Methodology: Electrocardiogram and electrical activity of the diaphragm (Edi) were recorded during 30min on each mode. Analysis of heart rate variability (HRV), diaphragmatic activity (Edi area, breath area, amplitude, inspiratory and expiratory times) and respiratory variability (RV) were compared between modes. Results: 23 enrolled infants had full data recordings and analysis: median [IQR] gestational age = 25.9 weeks [25.2-26.4], BW = 760g [595-900], and post-natal age 7 [4-19] days. There were no differences in HRV parameters between modes. During NIV-NAVA and NIPPV, diaphragmatic activity was significantly lower and RV higher than NCPAP. Delivered peak inflation pressures (PIPs) were lower during NIV-NAVA than NIPPV (14 cmH2O [13-16] vs cmH2O 16 [16-17]; p<0.001). However, due to a significantly higher proportion of assisted breaths (99% [92-103] vs. 51% [38-82]; p<0.001) NIV-NAVA provided a higher mean airway pressure (MAP)(9.4 cmH2O [8.2-10.0] vs. 8.2 cmH2O [7.6-9.3]; p=0.002). Conclusions: NIV-NAVA and NIPPV applied shortly after extubation were associated with positive cardiorespiratory effects. This effect was more evident during NIV-NAVA where patient-ventilator synchronization provided a higher MAP with lower PIPs.

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“…The reasons underpinning our success may be found in the evidence base for each individual intervention we adopted in our “BPD Prevention Bundle of Interventions” and “No BPD Roadmap.” The postnatal interventions of varying degrees of evidence supporting efficacy in preventing BPD included high-frequency ventilation 24 ; volume-targeted ventilation 25 ; surfactant therapy 26 , 27 ; CPAP use 15 , 25 , 28 , 29 , 30 , 31 ; administration of caffeine 32 , 33 , 34 , 35 ; vitamin A 36 , 37 , 38 ; azithromycin 39 ; human breast milk 40 ; and inhaled or systemic steroids 41 , 42 , 43 , 44 , 45 ; and lowered oxygen saturation targets of 85% to 95% up to 34 weeks’ gestation. 46 , 47 The interventions that we adopted that improved various aspects of short-term respiratory function, although they have not yet been shown to decrease BPD, included the use of extended CPAP, 48 neurally adjusted ventilatory assist, 25 , 28 , 29 , 30 , 40 high-flow nasal cannula, 49 , 50 , 51 , 52 and inhaled β-agonists. 53 Permissive hypercarbia and the use of diuretics were not encouraged in our bundle.…”

Section: Discussionmentioning

confidence: 99%

Rates of Bronchopulmonary Dysplasia Following Implementation of a Novel Prevention Bundle

et al. 2021

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IMPORTANCE Bronchopulmonary dysplasia (BPD) rates in the United States remain high and have changed little in the last decade. OBJECTIVE To develop a consistent BPD prevention bundle in a systematic approach to decrease BPD. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study included 484 infants with birth weights from 501 to 1500 g admitted to a level 3 neonatal intensive care unit in the Kaiser Permanente Southern California system from 2009 through 2019. The study period was divided into 3 periods: 1, baseline (2009); 2, initial changes based on ongoing cycles of Plan-Do-Study-Act (2010-2014); and 3, full implementation of successive Plan-Do-Study-Act results (2015-2019).INTERVENTIONS A BPD prevention system of care bundle evolved with a shared mental model that BPD is avoidable. MAIN OUTCOMES AND MEASURESThe primary outcome was BPD in infants with less than 33 weeks' gestational age (hereafter referred to as BPD <33). Other measures included adjusted BPD <33, BPD severity grade, and adjusted median postmenstrual age (PMA) at hospital discharge.Balancing measures were adjusted mortality and adjusted mortality or specified morbidities. RESULTSThe study population included 484 infants with a mean (SD) birth weight of 1070 (277) g; a mean (SD) gestational age of 28.6 (2.9) weeks; 252 female infants (52.1%); and 61 Black infants (12.6%). During the 3 study periods, BPD <33 decreased from 9 of 29 patients (31.0%) to 3 of 184 patients (1.6%) (P < .001 for trend); special cause variation was observed. The standardized morbidity ratio for the adjusted BPD <33 decreased from 1.2 (95% CI, 0.7-1.9) in 2009 to 0.4 (95% CI, 0.2-0.8) in 2019. The rates of combined grades 1, 2, and 3 BPD decreased from 7 of 29 patients (24.1%) to 17 of 183 patients (9.3%) (P < .008 for trend). Grade 2 BPD rates decreased from 3 of 29 patients (10.3%) to 5 of 183 patients (2.7%) (P = .02 for trend). Adjusted median PMA at home discharge decreased by 2 weeks, from 38.2 (95% CI, 37.3-39.1) weeks in 2009 to 36.8 (95% CI, 36.6-37.1) weeks during the last 3 years (2017-2019) of the full implementation period. Adjusted mortality was unchanged, whereas adjusted mortality or specified morbidities decreased significantly. CONCLUSIONS AND RELEVANCEA sustained low rate of BPD was observed in infants after the implementation of a detailed BPD system of care.

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Comparison of extubation success using noninvasive positive pressure ventilation (NIPPV) versus noninvasive neurally adjusted ventilatory assist (NI-NAVA)

Cited by 28 publications

References 35 publications

Effects of heliox and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants

Effects of heliox and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants

Cardiorespiratory effects of NIV-NAVA, NIPPV, and NCPAP shortly after extubation in extremely preterm infants: a randomized crossover trial

Rates of Bronchopulmonary Dysplasia Following Implementation of a Novel Prevention Bundle

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