Noninvasive Neurally Adjusted Ventilatory Assist Versus High Flow Cannula Support After Congenital Heart Surgery

Abstract

Background: Extubation failure rates for critical patients in pediatric intensive care units (ICUs) range from 5% to 29%. Noninvasive (NIV) ventilation has been shown to decrease extubation failure. We compared reintubation rates and outcomes of patients supported with NIV neurally adjusted ventilation assist (NAVA) versus historical controls supported with high-flow nasal cannula (HFNC). Methods: Case–control study of infants less than three months of age who underwent cardiac surgery and received NIV support after extubation from January 2011 to May 2017. All patients supported with NIV NAVA after it became available in September 2013 were compared to matched patients extubated to HFNC from prior to September 2013. Results: Forty-two patients identified for the NIV NAVA group were matched with 42 historical controls supported with HFNC. Groups had similar baseline characteristics based on rate of acute kidney injury, number of single ventricle patients, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category, age, weight, bypass time, and duration of intubation. There was no significant difference in reintubation rates within 72 hours (14.3% in the HFNC group and 16.7% in the NIV NAVA group, P = 1.0). Median duration from extubation to coming off NIV support was longer in the NIV NAVA group (3.6 days vs 0.6 days, P < .001). Median time from extubation to ICU discharge was longer in the NIV NAVA group (10.5 vs 6.8 days, P = .02), as was total postoperative ICU length of stay (LOS; 17.6 vs 12.2, P = .01). Conclusions: Introduction of NIV NAVA for postextubation support did not reduce reintubation rates compared to HFNC. Further study is needed as adoption of NIV NAVA may prolong LOS.

Comparison of High-flow Nasal Cannula (HFNC) and Conventional Oxygen Therapy in Obese Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis

“…Different from our results, some studies (33,34) have suggested the postoperative use of HFNC can reduce reintubation, but there is a lack of relevant studies for obese or cardiac surgery patients. Compared with COT, the use of HFNC can shorten the length of stay in the ICU (35,36). Our results showed that this is not consistent among obese patients undergoing cardiac surgery.…”

“…Two studies reported the dyspnea score at 24 h postoperative and in vivo 35 7). Using a random-effects model, the result was not found to be statistically significant (p=0.69).…”

Noninvasive neurally adjusted assisted ventilation as weaning mode in extremely preterm infants: a meta-analysis and systematic review

“…In a cohort study focused on ventilation in premature neonates after weaning, NIV-NAVA and NIPPV exhibited the same ventilatory efficiency 19 . In a case-control study NIV-NAVA was selected as weaning mode for ventilatory support of term infants after congenital heart surgery which did not contribute to extubated success, compared with selecting HFNC 34 . Consequently, whether NIV-NAVA is superior to conventional NIV remains controversial.…”

Respiratory Care for Neonates With Congenital Heart Disease

“…119 Noninvasive NAVA after extubation has not shown to be specifically helpful. 120 Invasive support requires placement of an endotracheal tube. Because their patients often require invasive support for extended periods, neonatologists prefer uncuffed tubes, 29 tolerating and compensating for leaks around the tube in the interest of minimizing pressure injury to the tracheal mucosa and risk for subsequent subglottic or tracheal stenosis.…”