Neurally adjusted ventilatory assist improves patient–ventilator interaction

Piquilloud, Lise; Vignaux, Laurence; Bialais, Émilie; Roeseler, Jean; Sottiaux, Thierry; Laterre, Pierre‐François; Jolliet, Philippe; Tassaux, Didier

doi:10.1007/s00134-010-2052-9

Cited by 206 publications

(217 citation statements)

References 35 publications

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“…Neural inspiratory time (T in ) was defined, according to previously published NAVA studies [13][14][15]19], as the time difference between the initial increase and the maximal value of EAdi (EAdi max ). Details on this point are given in the Electronic Supplementary Material.…”

Section: Measurementsmentioning

confidence: 99%

“…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%

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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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Section: Measurementsmentioning

confidence: 99%

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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“…Prior to this study, Piquilloud et al [7] examined the patient-ventilator asynchronies in pressure support and NAVA, namely ineffective effort, auto-triggering, premature cycling, delayed cycling and double triggering. …”

Section: Discussionmentioning

confidence: 99%

“…This research analyses prospectively recorded Eadi-time and flow-time curves and derived parameters in a study exploring patient-ventilator synchrony on clinically based criteria [7] at the University Hospital of Geneva (Switzerland) and Cliniques Universitaires St-Luc (Brussels, Belgium). The study protocol was approved by the Ethics committee of both participating hospitals.…”

Section: Methodsmentioning

confidence: 99%

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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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Application of neurally adjusted ventilatory assist in ventilator weaning of infants ventilator weaning

Xiao¹,

Huang²,

Cheng³

et al. 2021

Brain and Behavior

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Background:To analyze the application of neurally adjusted ventilatory assist in ventilator weaning of infants.Methods: A total of 25 infants (15 boys and 10 girls) who were mechanically ventilated by PICU in Hubei Maternal and Child Health Hospital were selected as the study subjects. After the improvement of the basic disease, regular spontaneous breathing, and the withdrawal of the ventilator, all the children obtained the electrical activity of the diaphragm (EAdi) signal. Then, each child was given CPAP and NAVA mode mechanical ventilation 1 h before the withdrawal of the ventilator. Each detection index was recorded 30 min after each mode of ventilation.Results: Two of the 25 children were tracheotomized because of respiratory muscle weakness and could not be converted to NAVA mode without the EAdi signal. Hemodynamic indexes were not statistically different between the two groups of CPAP and NAVA. PaCO 2 is not significantly different in the two modes, and both were at normal levels. The PIP in NAVA mode is lower than that in CPAP mode (p < .05), and its EAdi signal was correspondingly low. There were significant differences in the peak pressure (Ppeak), mean pressure (Pmean), and compliance and mean arterial pressure (p < .01) between the CPAP and NAVA model ventilation in 23 patients. Conclusion:NAVA can significantly improve the coordination of patients. The therapeutic effect of NAVA was better, which was beneficial to the prognosis of patients and had positive application value in the withdrawal of ventilators in patients.

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Neurally adjusted ventilatory assist improves patient–ventilator interaction

Abstract: Compared with standard PS, NAVA can improve patient-ventilator synchrony in intubated spontaneously breathing intensive care patients. Further studies should aim to determine the clinical impact of this improved synchrony.

Cited by 206 publications

References 35 publications

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

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

Application of neurally adjusted ventilatory assist in ventilator weaning of infants ventilator weaning

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