Neurally adjusted ventilatory assist for children on veno-venous ECMO

Assy, Jana; Mauriat, Philippe; Tafer, Nadir; Soulier, Sylvie; El‐Rassi, Issam

doi:10.1007/s10047-018-01087-y

Cited by 9 publications

(5 citation statements)

References 41 publications

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“…Among all the ventilatory strategies, the use of neurally adjusted ventilatory assist could also have a significant positive impact in these patients. Assy et al (28) reported the first pediatric report of Veno-Venous ECMO in six children suffering from P-ARDS. The delay for ECMO weaning was significantly shorter in the NAVA group comparing to the control group.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of implementation of a protective mechanical ventilation bundle during extracorporeal membrane oxygenation for pediatric acute respiratory distress syndrome

et al. 2022

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Objective: Defining the best ventilatory settings under ECMO remains a challenging question. Despite a well-defined ARDS treatment before ECMO initiation, there is no recommendation on how to ventilate a patient under ECMO for P-ARDS. Only a few descriptive studies are available on ventilatory settings during respiratory ECMO. We aim at evaluating the usefulness of a protective ventilation bundle under ECMO and its capacity to reduce the ventilatory pressure in our ECMO center.Methods: We performed a monocentric retrospective study from January 2007 to December 2018. All children aged from 1 month to 18 years old and requiring an extracorporeal membrane oxygenation for a refractory acute respiratory distress syndrome were included. A protective mechanical ventilation under ECMO bundle has been developed in 2014. We compare the period 1 (before 2014) to the period 2 (after 2014).Results: Eighty-three patient had been included during the study. We reported a significant increase of PEEP and mean pressure respectively at day 3, day 7 and day 14 of ECMO during the period 2. Conversely, the driving pressure were significantly lower in the period 2 at day 3 (p: 0.009), day 7 (p:0.001) and day 14 (p: 0.001). We also shown a strong increase in the use of prone positioning during ECMO in the period 2 (p: 0.01). There was no significant effect of our bundle on the length of mechanical ventilation, of hospitalization and on the survival rate. Conclusion:The implementation of a protective mechanical ventilation bundle during ECMO is usefulness to apply for lower ventilatory pressure and higher use of prone positioning.Nonetheless, the lack of power of our study prevents us from showing its efficacy on outcome criteria.

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Section: Discussionmentioning

confidence: 99%

Usefulness of implementation of a protective mechanical ventilation bundle during extracorporeal membrane oxygenation for pediatric acute respiratory distress syndrome

et al. 2022

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Section: Discussionmentioning

confidence: 99%

“…Another study showed that NAVA is safe in children on extracorporeal membrane oxygenation because it allows the children to drive the mechanical ventilator and regulate the tidal volume according to their needs. 25 Another study demonstrated that oxygenation improved during NAVA. 4 We found that similar to PSV, NAVA could maintain a suitable PaCO 2 and PaO 2 during a long period (24 hours) of mechanical ventilation.…”

Section: Respiratory Pattern and Gas Exchange During Navamentioning

confidence: 99%

Neurally adjusted ventilatory assist after surgical treatment of intracerebral hemorrhage: a randomized crossover study

Yao

et al. 2020

J Int Med Res

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Objective We assessed the neuromechanical efficiency (NME), neuroventilatory efficiency (NVE), and diaphragmatic function effects between pressure support ventilation (PSV) and neutrally adjusted ventilatory assist (NAVA). Methods Fifteen patients who had undergone surgical treatment of intracerebral hemorrhage were enrolled in this randomized crossover study. The patients were assigned to PSV for the first 24 hours and then to NAVA for the following 24 hours or vice versa. The monitored ventilatory parameters under the two ventilation models were compared. NME, NVE, and diaphragmatic function were compared between the two ventilation models. Results One patient’s illness worsened during the study. The study was stopped for this patient, and intact data were obtained from the other 14 patients and analyzed. The monitored tidal volume was significantly higher with PSV than NAVA (487 [443–615] vs. 440 [400–480] mL, respectively). NME, NVE, diaphragmatic function, and the partial pressures of arterial carbon dioxide and oxygen were not significantly different between the two ventilation models. Conclusion The tidal volume was lower with NAVA than PSV; however, the patients’ selected respiratory pattern during NAVA did not change the NME, NVE, or diaphragmatic function. Clinical trial registration no. ChiCTR1900022861

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“…In a retrospective small series published by Assy et al, the use of NAVA in pediatric patients on ECMO was found to be safe and feasible, and potentially helpful in the ECMO weaning process. 70 To implement NAVA, use of a nasogastric tube is needed to assess diaphragm electrical activity. It is important to assess the patient before introducing a new nasogastric tube and minimize injuries to the gastrointestinal tract leading to inadvertent bleeding.…”

Section: Neurally Adjusted Ventilatory Assistmentioning

confidence: 99%

Mechanical Ventilation during ECMO: Lessons from Clinical Trials and Future Prospects

Fior

Colon

Peek

et al. 2022

Semin Respir Crit Care Med

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Acute Respiratory Distress Syndrome (ARDS) accounts for 10% of ICU admissions and affects 3 million patients each year. Despite decades of research, it is still associated with one of the highest mortality rates in the critically ill. Advances in supportive care, innovations in technologies and insights from recent clinical trials have contributed to improved outcomes and a renewed interest in the scope and use of Extracorporeal life support (ECLS) as a treatment for severe ARDS, including high flow veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) and low flow Extracorporeal Carbon Dioxide Removal (ECCO2R). The rationale being that extracorporeal gas exchange allows the use of lung protective ventilator settings, thereby minimizing ventilator-induced lung injury (VILI). Ventilation strategies are adapted to the patient's condition during the different stages of ECMO support. Several areas in the management of mechanical ventilation in patients on ECMO, such as the best ventilator mode, extubation-decannulation sequence and tracheostomy timing, are tailored to the patients' recovery. Reduction in sedation allowing mobilization, nutrition and early rehabilitation are subsequent therapeutic goals after lung rest has been achieved.

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Neurally adjusted ventilatory assist for children on veno-venous ECMO

Cited by 9 publications

References 41 publications

Usefulness of implementation of a protective mechanical ventilation bundle during extracorporeal membrane oxygenation for pediatric acute respiratory distress syndrome

Usefulness of implementation of a protective mechanical ventilation bundle during extracorporeal membrane oxygenation for pediatric acute respiratory distress syndrome

Neurally adjusted ventilatory assist after surgical treatment of intracerebral hemorrhage: a randomized crossover study

Mechanical Ventilation during ECMO: Lessons from Clinical Trials and Future Prospects

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