Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults: a French multicentre randomized trial

Abstract

clinicaltrials.gov Identifier: NCT02018666.

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.…”

No harm, no benefit: should we give up with neurally adjusted ventilatory assist?

“…In a recent multicenter RCT, early application of high frequency oscillation in adults with moderate-to-severe ARDS not only failed to reduce but actually increased in-hospital mortality, as compared to a protective ventilation strategy [9]. As Demoule et al remark, though this RCT fails to find differences in efficacy between NAVA and PSV, it indicates that NAVA is safe and feasible over a prolonged period of time [8].…”

“…However, as proposed by the Demoule et al [8], NAVA could be beneficial only in specific patient groups with severe asynchrony and problematic weaning; therefore, as their study includes patients with ARF regardless of the precipitating factor, the effects of NAVA could be somewhat diluted.…”

“…In a recent article in Intensive Care Medicine, Demoule et al attempt to address this issue with a multicenter randomized clinical trial (RCT) comparing NAVA with a broadly used mode of partial support, pressure support ventilation (PSV), in 118 patients in the early phase of weaning from mechanical ventilation [8]. As expected, compared to PSV, NAVA lowered the rate of asynchrony.…”

“…Demoule et al [8] enrolled their patients in academic centers highly experienced in mechanical ventilation, which may not reflect the "real world". This also makes it possible, as suggested by the authors, that the rate of controls not remaining in PSV is too low to prevent additional improvement.…”