Neuro-ventilatory efficiency during weaning from mechanical ventilation using neurally adjusted ventilatory assist

Rozé, Hadrien; Repusseau, Benjamin; Perrier, Virginie; Germain, Arnaud; Séramondi, R.; Dewitte, Antoine; Fleureau, Catherine; Ouattara, Alexandre

doi:10.1093/bja/aet258

Cited by 40 publications

(25 citation statements)

References 19 publications

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“…We processed and analyzed the data using MatLab (Mathworks, MA, USA), which automatically detected the initiation and termination of inspiratory efforts and ventilator cycles, and calculated peak airway pressure (Paw), neural inspiratory time (TIneural), ventilator inspiratory time (TIvent), respiratory rate (RR), tidal volume (V T ) in mL/kg of ideal body weight, and ΔEAdi, which is defined as EAdi peak minus EAdi minimal. Neuro ventilatory efficiency was calculated as tidal volume (in mL) divided by ΔEAdi, in μV [ 25 ]. We excluded cycles with artifacts and, for every subject, we averaged all the cycles in each three-minute recording to generate mean values for the above variables.…”

Section: Methodsmentioning

confidence: 99%

Neurally Adjusted Ventilatory Assist (NAVA) or Pressure Support Ventilation (PSV) during spontaneous breathing trials in critically ill patients: a crossover trial

et al. 2017

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BackgroundNeurally Adjusted Ventilatory Assist (NAVA) is a proportional ventilatory mode that uses the electrical activity of the diaphragm (EAdi) to offer ventilatory assistance in proportion to patient effort. NAVA has been increasingly used for critically ill patients, but it has not been evaluated during spontaneous breathing trials (SBT). We designed a pilot trial to assess the feasibility of using NAVA during SBTs, and to compare the breathing pattern and patient-ventilator asynchrony of NAVA with Pressure Support (PSV) during SBTs.MethodsWe conducted a crossover trial in the ICU of a university hospital in Brazil and included mechanically ventilated patients considered ready to undergo an SBT on the day of the study. Patients underwent two SBTs in randomized order: 30 min in PSV of 5 cmH2O or NAVA titrated to generate equivalent peak airway pressure (Paw), with a positive end-expiratory pressure of 5 cmH2O. The ICU team, blinded to ventilatory mode, evaluated whether patients passed each SBT. We captured flow, Paw and electrical activity of the diaphragm (EAdi) from the ventilator and used it to calculate respiratory rate (RR), tidal volume (VT), and EAdi. Detection of asynchrony events used waveform analysis and we calculated the asynchrony index as the number of asynchrony events divided by the number of neural cycles.ResultsWe included 20 patients in the study. All patients passed the SBT in PSV, and three failed the SBT in NAVA. Five patients were reintubated and the extubation failure rate was 25% (95% CI 9–49%). Respiratory parameters were similar in the two modes: VT = 6.1 (5.5–6.5) mL/Kg in NAVA vs. 5.5 (4.8–6.1) mL/Kg in PSV (p = 0.076) and RR = 27 (17–30) rpm in NAVA vs. 26 (20–30) rpm in PSV, p = 0.55. NAVA reduced AI, with a median of 11.5% (4.2–19.7) compared to 24.3% (6.3–34.3) in PSV (p = 0.033).ConclusionsNAVA reduces patient-ventilator asynchrony index and generates a respiratory pattern similar to PSV during SBTs. Patients considered ready for mechanical ventilation liberation may be submitted to an SBT in NAVA using the same objective criteria used for SBTs in PSV.Trial registrationClinicalTrials.gov (NCT01337271), registered April 12, 2011.Electronic supplementary materialThe online version of this article (10.1186/s12890-017-0484-5) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Neurally Adjusted Ventilatory Assist (NAVA) or Pressure Support Ventilation (PSV) during spontaneous breathing trials in critically ill patients: a crossover trial

et al. 2017

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“…The electrophysiological assessment of diaphragmatic electrical activity via a modified nasogastric tube (EAdi) is a new promising but almost unexplored technique for VIDD. The electromyographic signal describes the summation amplitude of electrical activity and allows assessment of neuronal respiratory drive and estimation of neuro‐ventilatory efficiency (tidal volume divided by electrical activity) . Although there is lack of specific VIDD studies, this approach may hold potential for respiratory monitoring as it incorporates the neuronal feedback loop of the respiratory drive .…”

Section: Clinical Approaches To Respiratory Muscle Dysfunction/viddmentioning

confidence: 99%

“…The electromyographic signal describes the summation amplitude of electrical activity and allows assessment of neuronal respiratory drive and estimation of neuroventilatory efficiency (tidal volume divided by electrical activity). [94][95][96][97] Although there is lack of specific VIDD studies, this approach may hold potential for respiratory monitoring as it incorporates the neuronal feedback loop of the respiratory drive. 93,94,97 Further studies are warranted.…”

Section: Clinical Approaches To Respiratory Muscle Dysfunction/viddmentioning

confidence: 99%

Dysfunction of respiratory muscles in critically ill patients on the intensive care unit

Berger

Bloechlinger

Haehling

et al. 2016

J cachexia sarcopenia muscle

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Muscular weakness and muscle wasting may often be observed in critically ill patients on intensive care units (ICUs) and may present as failure to wean from mechanical ventilation. Importantly, mounting data demonstrate that mechanical ventilation itself may induce progressive dysfunction of the main respiratory muscle, i.e. the diaphragm. The respective condition was termed ‘ventilator‐induced diaphragmatic dysfunction’ (VIDD) and should be distinguished from peripheral muscular weakness as observed in ‘ICU‐acquired weakness (ICU‐AW)’.Interestingly, VIDD and ICU‐AW may often be observed in critically ill patients with, e.g. severe sepsis or septic shock, and recent data demonstrate that the pathophysiology of these conditions may overlap. VIDD may mainly be characterized on a histopathological level as disuse muscular atrophy, and data demonstrate increased proteolysis and decreased protein synthesis as important underlying pathomechanisms. However, atrophy alone does not explain the observed loss of muscular force. When, e.g. isolated muscle strips are examined and force is normalized for cross‐sectional fibre area, the loss is disproportionally larger than would be expected by atrophy alone. Nevertheless, although the exact molecular pathways for the induction of proteolytic systems remain incompletely understood, data now suggest that VIDD may also be triggered by mechanisms including decreased diaphragmatic blood flow or increased oxidative stress. Here we provide a concise review on the available literature on respiratory muscle weakness and VIDD in the critically ill. Potential underlying pathomechanisms will be discussed before the background of current diagnostic options. Furthermore, we will elucidate and speculate on potential novel future therapeutic avenues.

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“…NVE has recently been used to study the physiological response to PEEP changes 17 and as a bedside monitor during weaning. 13 , 18 The NVE NAVA was calculated as the quotient between Vt and the integral of the inspiratory EAdi. The NVE NAVA median value over the 5-min period was obtained in our study for all the steps and compared between sevoflurane and propofol.…”

Section: Methodsmentioning

confidence: 99%

Neurally adjusted ventilatory assist feasibility during anaesthesia

Jalde

Sackey³

et al. 2016

European Journal of Anaesthesiology

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BACKGROUNDSpontaneous breathing during mechanical ventilation improves gas exchange by redistribution of ventilation to dependent lung regions. Neurally adjusted ventilatory assist (NAVA) supports spontaneous breathing in proportion to the electrical activity of the diaphragm (EAdi). NAVA has never been used in the operating room and no studies have systematically addressed the influence of different anaesthetic drugs on EAdi.OBJECTIVESThe aim of this study was to test the feasibility of NAVA under sedation and anaesthesia with two commonly used anaesthetics, sevoflurane and propofol, with and without remifentanil, and to study their effects on EAdi and breathing mechanics.DESIGNA crossover study with factorial design of NAVA during sedation and anaesthesia in pigs.SETTINGUniversity basic science laboratory in Uppsala, Sweden, from March 2009 to February 2011.ANIMALSNine juvenile pigs were used for the experiment.INTERVENTIONSThe lungs were ventilated using NAVA while the animals were sedated and anaesthetised with continuous low-dose ketamine combined with sevoflurane and propofol, with and without remifentanil.MAIN OUTCOME MEASURESDuring the last 5 min of each study period (total eight steps) EAdi, breathing pattern, blood gas analysis, neuromechanical efficiency (NME) and neuroventilatory efficiency (NVE) during NAVA were determined.RESULTSEAdi was preserved and normoventilation was reached with both sevoflurane and propofol during sedation as well as anaesthesia. Tidal volume (Vt) was significantly lower with sevoflurane anaesthesia than with propofol. NME was significantly higher with sevoflurane than with propofol during anaesthesia with and without remifentanil. NVE was significantly higher with sevoflurane than with propofol during sedation and anaesthesia.CONCLUSIONNAVA is feasible during ketamine-propofol and ketamine-sevoflurane anaesthesia in pigs. Sevoflurane promotes lower Vt, and affects NME and NVE less than propofol. Our data warrant studies of NAVA in humans undergoing anaesthesia.

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Neuro-ventilatory efficiency during weaning from mechanical ventilation using neurally adjusted ventilatory assist

Cited by 40 publications

References 19 publications

Neurally Adjusted Ventilatory Assist (NAVA) or Pressure Support Ventilation (PSV) during spontaneous breathing trials in critically ill patients: a crossover trial

Neurally Adjusted Ventilatory Assist (NAVA) or Pressure Support Ventilation (PSV) during spontaneous breathing trials in critically ill patients: a crossover trial

Dysfunction of respiratory muscles in critically ill patients on the intensive care unit

Neurally adjusted ventilatory assist feasibility during anaesthesia

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