Neural control of mechanical ventilation in respiratory failure

Sinderby, Christer A.; Navalesi, Paolo; Beck, Jennifer; Skrobik, Yoanna; Comtois, Norman; Friberg, Sven; Gottfried, S. B.; Lindström, Lars

doi:10.1038/71012

Cited by 555 publications

(452 citation statements)

References 29 publications

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“…Motions of the rib cage and abdomen were monitored by Respitrace bands placed over the rib cage (nipple level) and abdomen (umbilical level). Crural diaphragm electrical activity (Edi) was measured by a multi-array oesophageal electrode [13,15,16].…”

Section: Measurementsmentioning

confidence: 99%

Expiratory muscle pressure and breathing mechanics in chronic obstructive pulmonary disease

Shi¹,

Sinderby²,

Bieleń³

et al. 2000

Eur Respir J

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Expiratory muscle recruitment is common in stable chronic obstructive pulmonary disease (COPD) patients. Due to airway obstruction, there is little reason to believe that active expiration in COPD would be mechanically effective in lowering operating lung volume. The physiological significance of expiratory muscle recruitment in COPD, therefore, remains unknown. The purpose of this study was to assess, in COPD patients breathing at rest, the effect of expiratory muscle contraction on force generating ability of the diaphragm.The force generating ability of the diaphragm was evaluated from its pressure swing (Pdi) for a given diaphragm electrical activity (Edi), where Edi was normalized as % of its maximal value (Pdi/Edi/Edi,max). Phasic expiratory muscle contraction was measured as the total expiratory rise in gastric pressure (Pga,exp.rise).Nineteen seated patients with moderate to severe COPD, participated in the study and 10 exhibited phasic rise in Pga during expiration with a mean Pga,exp.rise of 1.91 0.89 cmH 2 O. The patients were thus divided into passive expiration (PE) and active expiration (AE) groups. There was no significant difference in various lung function and breathing pattern parameters between the two groups. Pdi/Edi/Edi,max was 0.63 0.07 and 0.54 0.07 cmH 2 O/% in PE and AE groups, respectively, and was not significantly different between each other. Compared with PE group, AE group not only recruited expiratory muscles, but also preferentially recruited inspiratory rib cage muscles and derecruited the diaphragm.The results do not support a significant improvement of the force-generating ability of the diaphragm by phasic contraction of expiratory muscles at rest in chronic obstructive pulmonary disease patients. Eur Respir J 2000; 16: 684±690.

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Section: Measurementsmentioning

confidence: 99%

Expiratory muscle pressure and breathing mechanics in chronic obstructive pulmonary disease

Shi¹,

Sinderby²,

Bieleń³

et al. 2000

Eur Respir J

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“…However, when delivering PS-NIV through a helmet, neural triggering has been shown to improve patient-ventilator synchrony compared to pneumatic triggering [11]. As neurally adjusted ventilatory assist (NAVA) [12] uses a neural signal (the diaphragm electrical activity, or EAdi, independent from airway pressure and flow signals), to trigger and cycle-off the ventilator as well as to adapt the amount of pressure delivered, and as NAVA improves patient-ventilator interaction during invasive ventilation [13][14][15][16], we hypothesized that NAVA could improve patient-ventilator synchrony during NIV. The purpose of this study was to test this hypothesis in adult intensive care patients requiring NIV because of acute respiratory failure or because of being at risk of respiratory failure after extubation [3].…”

Section: Introductionmentioning

confidence: 99%

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Piquilloud

Tassaux

Bialais³

et al. 2012

Intensive Care Med

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Purpose: To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask. Methods: In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T d ), the patient's neural inspiratory time (T in ), ventilator pressurization duration (T iv ), inspiratory time in excess (T iex ), number of asynchrony events per minute and asynchrony index (AI) were determined. Results: The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T d was reduced with NAVA: median 35 ms (IQR 31-53 ms) versus 181 ms (122-208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T iex value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5-3.1 events/min) versus 4.4 events/min (0.9-12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5-10.5 %) versus 15.8 % (5.5-49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO 2 and PaCO 2 were not different between ventilatory modes. Conclusion: Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T d and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.

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“…Neurally Adjusted Ventilatory Assist (NAVA) is an assisted mode that uses electrical activity of the diaphragm (Eadi), an expression of the patient's inspiratory demand, to trigger and cycle off the ventilator, as well as to deliver pressure in direct proportion to Eadi [5]. Compared to PS, NAVA improves patient-ventilator interaction by reducing trigger delay, improving expiratory cycling and reducing the number of asynchrony events [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand

Moorhead

Piquilloud²,

Lambermont

et al. 2012

J Clin Monit Comput

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Neural control of mechanical ventilation in respiratory failure

Cited by 555 publications

References 29 publications

Expiratory muscle pressure and breathing mechanics in chronic obstructive pulmonary disease

Expiratory muscle pressure and breathing mechanics in chronic obstructive pulmonary disease

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand

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