Neurally adjusted ventilatory assist in acute respiratory failure: a randomized controlled trial

Abstract

We hypothesized that neurally adjusted ventilatory assist (NAVA) compared to conventional lung-protective mechanical ventilation (MV) decreases duration of MV and mortality in patients with acute respiratory failure (ARF). Methods: We carried out a multicenter, randomized, controlled trial in patients with ARF from several etiologies. Intubated patients ventilated for ≤ 5 days expected to require MV for ≥ 72 h and able to breathe spontaneously were eligible for enrollment. Eligible patients were randomly assigned based on balanced treatment assignments with a computerized randomization allocation sequence to two ventilatory strategies: (1) lung-protective MV (control group), and (2) lung-protective MV with NAVA (NAVA group). Allocation concealment was maintained at all sites during the trial. Primary outcome was the number of ventilator-free days (VFDs) at 28 days. Secondary outcome was all-cause hospital mortality. All analyses were done according to the intention-to-treat principle. Results: Between March 2014 and October 2019, we enrolled 306 patients and randomly assigned 153 patients to the NAVA group and 153 to the control group. Median VFDs were higher in the NAVA than in the control group (22 vs. 18 days; between-group difference 4 days; 95% confidence interval [CI] 0 to 8 days; p = 0.016). At hospital discharge, 39 (25.5%) patients in the NAVA group and 47 (30.7%) patients in the control group had died (between-group difference − 5.2%, 95% CI − 15.2 to 4.8, p = 0.31). Other clinical, physiological or safety outcomes did not differ significantly between the trial groups. Conclusion: NAVA decreased duration of MV although it did not improve survival in ventilated patients with ARF.

Mechanical ventilation parameters in critically ill COVID-19 patients: a scoping review

“…It was also suggested that the mechanical ventilation of patients classified to these two clinical types of disease should also differ; those with stiff lungs should be ventilated in accordance with the recommendations for ARDS, and those with compliant lungs may be ventilated with higher tidal volumes (7–9 ml/kg ideal body weight) and lower PEEP (< 10 cmH 2 O) than recommended [ 49 ]. Subsequent studies conducted in larger patient populations did not confirm this observation [ 17 , 19 , 20 , 23 , 26 ]. Our review of the available literature, limited as it is to pooled data from multiple studies with different methodologies, also does not support the existence of a clinical dichotomy.…”

Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study

“…We have reported [ 2 , 3 ] that severe hypoxemia with relatively well-preserved respiratory system compliance (Crs) measured under standard conditions is characteristic of COVID-19-ARDS, and it differs from ARDS of other causes (typical ARDS), while others did not recognize consistent differences [ 4 – 7 ]. However, the increased frequency of higher Crs in COVID-19-ARDS was noted by some of the same authors [ 4 , 5 ], and a significantly higher Crs associated with severe hypoxemia was recently documented [ 8 ]. The heterogeneous nature of ARDS allows that—at the population level—there may be wide overlap between COVID-19-ARDS and typical ARDS, and these observations continue to drive a debate [ 6 , 9 ].…”

Neurally adjusted ventilatory assist as a weaning mode for adults with invasive mechanical ventilation: a systematic review and meta-analysis

“…1. Of the 75 studies, 7 studies met all inclusion criteria and were included in the nal quantitative synthesis [29][30][31][32][33][34][35]. The seven included studies comprised a total of 683 patients.…”

“…One of them was a published conference abstract [29]. Of note, 5 of the 7 studies (4 RCTs, 1 crossover trial) were included in the metaanalysis of weaning success [29][30][31][32][33].…”