Neurally adjusted ventilatory assist vs pressure support ventilation in infants recovering from severe acute respiratory distress syndrome: Nested study

Piastra, Marco; Luca, Danièle De; Costa, Roberta; Pizza, Alessandro; Sanctis, Renata De; Marzano, Laura; Biasucci, Daniele Guerino; Visconti, Federico; Conti, Giorgio

doi:10.1016/j.jcrc.2013.08.006

Cited by 50 publications

(54 citation statements)

References 35 publications

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“…The term “patient‐ventilator mode pairs” will be replaced simply by “patients” for the remainder of the manuscript. Six of the included studies were crossover studies while two of the included studies compared separate groups of patients with one being assigned to conventional ventilation and the other to NAVA. Five of the included studies were prospective in nature while the remaining three were retrospective.…”

Section: Resultsmentioning

confidence: 99%

Neurally adjusted ventilatory assist versus conventional ventilation in the pediatric population: Are there benefits?

Karikari

Rausa

Flores

et al. 2019

Pediatric Pulmonology

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Introduction Neurally‐adjusted ventilator assist (NAVA) is a relatively new form of ventilation in which the electrical activity of the diaphragm is sensed by a catheter. The amplitude of this electrical signal is then used to deliver an appropriately proportioned pressure supported breath to the patient. Due to the synchronous nature of the breaths and the patient‐adjusted nature of the support, NAVA has been shown to have benefits over conventional ventilation. Meta‐analyses were conducted of published pediatric studies to compare ventilatory endpoints between NAVA and conventional ventilation. Methods Studies comparing ventilatory parameters between NAVA and conventional ventilation in pediatric patients were identified. These studies were reviewed for appropriateness for inclusion and studies of only pediatric patients with data for similar endpoints between both arms were then pooled. Results Statistically significant differences were noted in asynchrony, peak inspiratory pressure (PIP), and oxygen saturation by pulse oximetry. Asynchrony was 17% lower with NAVA, PIP was 1.74 cmH20 lower with NAVA, and oxygen saturation was 1.1% greater with NAVA. There was no statistically significant difference in peak expiratory pressure, mean airway pressure, electrical diaphragmatic activity, respiratory rate, hydrogen ion concentration, partial pressure of oxygen, or partial pressure of carbon dioxide. Conclusion Statistically significant differences were noted in percent asynchrony, PIP, and oxygen saturation when comparing NAVA to conventional ventilation. These all tended to favor NAVA. Other than percent asynchrony, however, the other statistically significant findings were not clinically significant.

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Section: Resultsmentioning

confidence: 99%

Neurally adjusted ventilatory assist versus conventional ventilation in the pediatric population: Are there benefits?

Karikari

Rausa

Flores

et al. 2019

Pediatric Pulmonology

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“…In pediatric patients beyond the neonatal age, NAVA has repeatedly been shown to improve patient-ventilator interaction and synchrony [4,5,6,7,8], with the potential for improving the outcome of mechanical ventilation and reducing its duration.…”

Section: Introductionmentioning

confidence: 99%

Neurally Adjusted Ventilatory Assist in Preterm Neonates with Acute Respiratory Failure

Longhini¹,

Ferrero

Luca

et al. 2014

Neonatology

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Background: Neurally adjusted ventilatory assist (NAVA) is a novel mode of ventilation that has been demonstrated to improve infant-ventilator interaction, compared to the conventional modes in retrospective and short-term studies. Objectives: To prospectively evaluate the physiologic effects of NAVA in comparison with pressure-regulated volume control (PRVC) in two nonrandomized 12-hour periods. Methods: We studied 14 consecutive intubated preterm neonates receiving mechanical ventilation for acute respiratory failure. Peak airway pressure (Paw_peak), diaphragm electrical activity (EAdi), tidal volume (V_T), mechanical (RR_mec) and neural (RR_neu) respiratory rates, neural apneas, and the capillary arterialized blood gases were measured. The RR_mec-to-RR_neu ratio (MNR) and the asynchrony index were also calculated. The amount of fentanyl administered was recorded. Results: Paw_peak and V_T were greater in PRVC (p < 0.01). Blood gases and RR_mec were not different between modes, while RR_neu and the EAdi swings were greater in NAVA (p = 0.02 and p < 0.001, respectively). MNR and the asynchrony index were remarkably lower in NAVA than in PRVC (p = 0.03 and p < 0.001, respectively). 1,841 neural apneas were observed during PRVC, with none in NAVA. Less fentanyl was administered during NAVA, as opposed to PRVC (p < 0.01). Conclusions: In acutely ill preterm neonates, NAVA can be safely and efficiently applied for 12 consecutive hours. Compared to PRVC, NAVA is well tolerated with fewer sedatives.

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“…NAVA delivers mechanical assistance in proportion to patient effort, allowing the tailoring of the mechanical support to patient' respiratory characteristics. Several studies 15,[22][23][24][25][26] showed that NAVA is a safe and reliable mode in the pediatric and infant population. It improved synchrony and patient comfort, reduced ventilator drive, and increased breath-tobreath mechanical variability.…”

Section: Discussionmentioning

confidence: 99%

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Conti

Gregoretti²,

Spinazzola

et al. 2015

Respir Care

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BACKGROUND: In adults and children, patient-ventilator synchrony is strongly dependent on both the ventilator settings and interface used in applying positive pressure to the airway. The aim of this bench study was to determine whether different interfaces and ventilator settings may influence patient-ventilator interaction in pediatric models of normal and mixed obstructive and restrictive respiratory conditions. METHODS: A test lung, connected to a pediatric mannequin using different interfaces (endotracheal tube [ETT], face mask, and helmet), was ventilated in pressure support ventilation mode testing 2 ventilator settings (pressurization time [Time press ] 50% /cycling-off flow threshold [Tr exp ] 25% , Time press80% /Tr exp60% ), randomly applied. The test lung was set to simulate one pediatric patient with a healthy respiratory system and another with a mixed obstructive and restricted respiratory condition, at different breathing frequencies (f) (30, 40, and 50 breaths/min). We measured inspiratory trigger delay, pressurization time, expiratory trigger delay, and time of synchrony. RESULTS: At each breathing frequency, the helmet showed the longest inspiratory trigger delay compared with the ETT and face mask. At f 30 , the ETT had a reduced T press . The helmet had the shortest T press in the simulated child with a mixed obstructive and restricted respiratory condition, at f 40 during Time press50% /Tr exp25% and at f 50 during Time press80% /Tr exp60% . In the simulated child with a normal respiratory condition, the ETT presented the shortest T press value at f 50 during Time press80% /Tr exp60% . Concerning the expiratory trigger delay, the helmet showed the best interaction at f 30 , but the worst at f 40 and at f 50 . The helmet showed the shortest time of synchrony during all ventilator settings. CONCLUSIONS: The choice of the interface can influence patient-ventilator synchrony in a pediatric model breathing at increased f, thus making it more difficult to set the ventilator, particularly during noninvasive ventilation. The helmet demonstrated the worst interaction, suggesting that the face mask should be considered as the first choice for delivering noninvasive ventilation in a pediatric model.

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Neurally adjusted ventilatory assist vs pressure support ventilation in infants recovering from severe acute respiratory distress syndrome: Nested study

Cited by 50 publications

References 35 publications

Neurally adjusted ventilatory assist versus conventional ventilation in the pediatric population: Are there benefits?

Neurally adjusted ventilatory assist versus conventional ventilation in the pediatric population: Are there benefits?

Neurally Adjusted Ventilatory Assist in Preterm Neonates with Acute Respiratory Failure

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

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