Comparison of NIV-NAVA and NCPAP in facilitating extubation for very preterm infants

Abstract

Background Various types of noninvasive respiratory modalities that lead to successful extubation in preterm infants have been explored. We aimed to compare noninvasive neurally adjusted ventilatory assist (NIV-NAVA) and nasal continuous positive airway pressure (NCPAP) for the postextubation stabilization of preterm infants. Methods This retrospective study was divided into two distinct periods, between July 2012 and June 2013 and between July 2013 and June 2014, because NIV-NAVA was applied beginning in July 2013. Preterm infants of less than 30 weeks GA who had been intubated with mechanical ventilation for longer than 24 h and were weaned to NCPAP or NIV-NAVA after extubation were enrolled. Ventilatory variables and extubation failure were compared after weaning to NCPAP or NIV-NAVA. Extubation failure was defined when infants were reintubated within 72 h of extubation. Results There were 14 infants who were weaned to NCPAP during Period I, and 2 infants and 16 infants were weaned to NCPAP and NIV-NAVA, respectively, during Period II. At the time of extubation, there were no differences in the respiratory severity score (NIV-NAVA 1.65 vs. NCPAP 1.95), oxygen saturation index (1.70 vs. 2.09) and steroid use before extubation. Several ventilation parameters at extubation, such as the mean airway pressure, positive end-expiratory pressure, peak inspiratory pressure, and FiO 2 , were similar between the two groups. SpO 2 and pCO 2 preceding extubation were comparable. Extubation failure within 72 h after extubation was observed in 6.3% of the NIV-NAVA group and 37.5% of the NCPAP group ( P = 0.041). Conclusions The data in the present showed promising implications for using NIV-NAVA over NCPAP to facilitate extubation.

2019 Year in Review: Neonatal Respiratory Support

“…These authors found that the re-intubation rate was significantly lower in the NIV-NAVA group (12% vs 50%, P ¼ .02) despite a significantly longer duration of invasive ventilation (5.5 vs 12.4 d, P ¼ .04). Consistent with these findings, Lee and colleagues 51 reported a reduction in extubation failure for infants < 30 weeks gestational age who received NIV compared with CPAP (6% vs 38%, P ¼ .041). Although these results are encouraging, both studies were retrospective by design and had a limited sample size.…”

Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia—Where Are We in 2021?

“…Yagui et al conducted a RCT ( n = 123) comparing NIV-NAVA vs. NCPAP as the primary support in infants with BW <1500 g. There was no difference noted in the primary outcome of need for intubation prior to 72 hours of life, or for the secondary outcome of BPD, between the two groups [ 82 ]. Other small RCTs have shown that NIV-NAVA is as effective as NCPAP in preventing extubation failure, but large RCTs studying the outcome of BPD in extremely preterm infants are needed before NIV-NAVA can be routinely recommended [ 83 , 84 , 85 , 86 , 87 ].…”

Histogram analysis for bedside respiratory monitoring in not critically ill preterm neonates: a proposal for a new way to look at the monitoring data

“…NAVA improves synchrony in patients with respiratory support by detecting the electrical activity of the diaphragm and may offer potential benefits in neonatal ventilation. Again, it has been shown to be superior to CPAP in facilitating extubation in preterm infants in small studies [5]. So, it seems that a synchronised modality of consistent pressure delivery might be superior to conventional modalities of NIV, but their use across neonatal units is still limited.…”