Multicenter Experience with Neurally Adjusted Ventilatory Assist in Infants with Severe Bronchopulmonary Dysplasia

Abstract

Objective The aim of this study is to determine patterns of neurally adjusted ventilatory assist (NAVA) use in ventilator-dependent preterm infants with evolving or established severe bronchopulmonary dysplasia (sBPD) among centers of the BPD Collaborative, including indications for its initiation, discontinuation, and outcomes. Study Design Retrospective review of infants with developing or established sBPD who were placed on NAVA after ≥4 weeks of mechanical ventilation and were ≥ 30 weeks of postmenstrual age (PMA). Results Among the 13 sites of the BPD collaborative, only four centers (31%) used NAVA in the management of infants with evolving or established BPD. A total of 112 patients met inclusion criteria from these four centers. PMA, weight at the start of NAVA and median number of days on NAVA, were different among the four centers. The impact of NAVA therapy was assessed as being successful in 67% of infants, as defined by the ability to achieve respiratory stability at a lower level of ventilator support, including extubation to noninvasive positive pressure ventilation or support with a home ventilator. In total 87% (range: 78–100%) of patients survived until discharge. Conclusion We conclude that NAVA can be used safely and effectively in selective infants with sBPD. Indications and current strategies for the application of NAVA in infants with evolving or established BPD, however, are highly variable between centers. Although this pilot study suggests that NAVA may be successfully used for the management of infants with BPD, sufficient experience and well-designed clinical studies are needed to establish standards of care for defining the role of NAVA in the care of infants with sBPD.

Respiratory support strategies in the management of severe, longstanding bronchopulmonary dysplasia

“…Despite consensus recommendations from collaborating centers, significant variations in care have been documented ( 21 ). In a recent publication from the Children's Hospital Neonatal Consortium (CHNC), researchers found significant differences in ventilator modes and practices; 51% were treated with volume-control or volume guarantee, 43% with pressure-control, and 6% with neurally adjusted ventilatory assist (NAVA) ( 28 ). The use of non-invasive modes was equally variable; 41% were treated with high-flow nasal cannula (HFNC), 28% with low-flow nasal cannula (LFNC), 26% with continuous positive airway pressure (CPAP), and 5% with other modes ( 28 ).…”

Proportional assist and neurally adjusted ventilation: Clinical knowledge and future trials in newborn infants

“…In multiple small prospective cross‐over studies in infants with RDS or evolving BPD, NAVA has been shown to reduce the PIP, the fraction of inspired oxygen, and the work of breathing compared with other patient‐triggered ventilatory modes 28,46–55 (Table 4). In a multi‐center review of current clinical practice, NAVA was successful as a weaning mode of ventilation in infants with severe BPD 67% of the time 56 …”

Effect of electrical activity of the diaphragm waveform patterns on SpO2 for extremely preterm infants ventilated with neurally adjusted ventilatory assist

“…In every waveform pattern, these median proportions were used as thresholds for dividing data units into the H-and L-groups. (e.g., in one unit, if the phasic pattern was 62%, the central apnea pattern was 13%, the irregular low-voltage pattern was 12%, and the tonic (15,16) 15 (14,16) .001…”

“…These infants develop an unstable respiratory condition or need to have their ventilatory mode changed from NAVA. [16][17][18] However, there are limited clinical indicators of whether infants can be appropriately ventilated by NAVA.…”