Neurally-Adjusted Ventilatory Assist (NAVA) versus Pneumatically Synchronized Ventilation Modes in Children Admitted to PICU

Sugunan, Pravin; Hosheh, Osama; Cusco, Mireia Garcia; Mildner, Reinout J

doi:10.3390/jcm10153393

Cited by 2 publications

(3 citation statements)

References 31 publications

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“…We have not assessed sensitivity and specificity of other extubation readiness scores ( 20), yet, every effort should be made to introduce effective MV strategies. Neurally adjusted ventilatory assist (NANA) might prove helpful in gradual weaning of patients with a well-trained respiratory therapist (21).…”

Section: Discussionmentioning

confidence: 99%

Predictors of Failed Extubation in Mechanically Ventilated Children: Single Center Experience

Ishak

Mohamed²,

El-Sherbini³

et al. 2022

Pediatric Sciences Journal

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Background: Extubation failure is failure to maintain normal spontaneous breathing after a period of mechanical ventilation with the need for reintubation within 24-72 hours. It has multiple risk factors such as deconditioned muscles, upper airway edema and others. Aim of the Work:To study the frequency and causes of extubation failure in mechanically ventilated children. Patients and Methods: This is an observational prospective study that included all admitted children in Pediatric Intensive Care Unit (PICU), Cairo University Children Hospital who underwent mechanical ventilation (MV) through endotracheal tube for more than 48 hours (145 child) with Glasgow coma scale above 8. They were subdivided into successfully extubated (78 children) and failed extubation (67 children). Results:The mean ± SD age of the cohort was 13.5 ± 15.15 months (range1.3-48, median= 8 months). Of them 80 (55.17%) were males, and 65 (44.8%) were females. The commonest underlying diagnosis was pneumonia in 38 (26.2%), bronchial asthma in 32 (22%), encephalopathy in 32 (22%), and aspiration in 11 (7.58%). Failed extubation was encountered in 67 (46.2%) children. The encountered risk factors of extubation failure were: sedation in 12 (16.7%) (p=0.001), excessive tracheal secretion of more than 200 ml /24 h in 14 (18.7%) (p=0.03), accidental extubation in 27 (40.3%) (p=0.01) and the need for higher setting on MV in all 67 children with failed extubation. Among failed extubated patients, the mean± SD for peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), and fraction of inspired oxygen (FiO2) were 14.5± 1.8 /cm H2O, 5.5± 0.5/cm H2O, and 27.5± 6.1% respectively. While, PIP, PEEP, and FiO2 in the successfully extubated group were 12.8± 1.6 /cm H2O, 4.1± 0.4/cm H2O, and 24.8± 5.3%, (p= 0.01, p=0.001 and p= 0.001) respectively. Patients who underwent gradual withdrawal of ventilatory support had a higher frequency of successful extubation than those extubated accidentally (p= 0.01). Sensitivity, and specificity of above mentioned indices for successful extubation were 53.79%, and 28.72% respectively. Conclusion: Causes of extubation failure are the need for long duration of sedation, excessive tracheal secretion, and need for high setting on MV. Furthermore, gradual weaning decreases the frequency of extubation failure. There is a need for a more sensitive and specific comprehensive objective indicator(s) for successful timely extubation.

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Section: Discussionmentioning

confidence: 99%

Predictors of Failed Extubation in Mechanically Ventilated Children: Single Center Experience

Ishak

Mohamed²,

El-Sherbini³

et al. 2022

Pediatric Sciences Journal

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Section: Conventional Mechanical Ventilationmentioning

confidence: 99%

“…There are also novel modes of conventional ventilation utilizing triggers other than volume, pressure, or flow which are the standard triggers for ventilator breaths NAVA uses EAdi signal to trigger inspiration; this mode has been shown to improve the patient-ventilator synchrony and mitigate the risk of ventilator over assistance when compared with pressure support ventilation 3,8. Pediatric studies have shown that the use of NAVA significantly reduced the duration of mechanical ventilation, length of stay, and sedative requirement in children with lung disease; however, more studies are needed to more completely assess the effect of NAVA on clinical outcomes and treatment costs in ventilated children 10. 4 | NON CONVENTIONAL MECHANIC AL VENTIL ATI ON (HFOV, HJ V, HFPV, AND A PRV )When conventional ventilation fails to resolve issues of oxygenation and ventilation in severe lung disease, then nonconventional TA B L E 4 Recommended settings for conventional mechanical ventilation historically been applied in the neonatal and pediatric population 11.…”

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confidence: 99%

Update on ventilation management in the Pediatric Intensive Care Unit

Egbuta

Easley

2021

Pediatric Anesthesia

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Studies have shown that up to 63% of pediatric intensive care unit patients admitted with acute respiratory or cardiorespiratory illness require mechanical ventilation. Mechanical ventilator support can be divided into three phases: initiation, escalation, and resolution. Noninvasive ventilation is typical during the initiation phase in the management of acute pediatric respiratory failure. The major advancements in the use of noninvasive ventilation involve the emergence of high-flow nasal cannula and how widespread the use of high-flow nasal cannula has become in pediatric critical care practice. When high-flow nasal cannula fails, escalation to continuous positive airway pressure or bi-level positive airway pressure is the next step in respiratory care progression. Careful clinical assessment is necessary to avoid delayed escalation between forms of noninvasive support or escalation to intubation and invasive mechanical ventilation. Advancements in conventional mechanical ventilation are centered on optimizing ventilator settings and customizing monitoring with the overarching goal to reduce complications of mechanical ventilation, such as ventilator-induced lung injury. New mechanical ventilator strategies integrating esophageal pressure monitoring, volumetric capnography, and neurally adjusted ventilator assist help to optimize conventional ventilator support. Nonconventional modes of ventilation in the intensive care unit are high-frequency modes and airway pressure release ventilation. Extracorporeal pulmonary support via extracorporeal membrane oxygenation or paracorporeal lung assist devices provides rescue options when conventional and nonconventional methods fail. During resolution of a course of mechanical ventilator support, reliable weaning strategies and extubation readiness testing are lacking in pediatric critical care. Further, timing of tracheostomy, risk reduction in ventilatorinduced lung injury, and decreased sedation requirements in pediatric patients requiring mechanical ventilation in the pediatric intensive care unit are areas of ongoing research.

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Neurally-Adjusted Ventilatory Assist (NAVA) versus Pneumatically Synchronized Ventilation Modes in Children Admitted to PICU

Cited by 2 publications

References 31 publications

Predictors of Failed Extubation in Mechanically Ventilated Children: Single Center Experience

Predictors of Failed Extubation in Mechanically Ventilated Children: Single Center Experience

Update on ventilation management in the Pediatric Intensive Care Unit

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