Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation

Cammarota, Gianmaria; Olivieri, Carlo; Costa, Roberta; Vaschetto, Rosanna; Colombo, Davide; Turucz, Emilia; Longhini, Federico; Corte, Francesco Della; Conti, Giorgio; Navalesi, Paolo

doi:10.1007/s00134-011-2382-2

Cited by 77 publications

(67 citation statements)

References 29 publications

(46 reference statements)

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“…Additionally, there were no ineffective efforts, no delayed cycling and no premature cycling during NAVA. These results are consistent with improved synchrony demonstrated in animals [21] and in low-birth-weight infants (using a single nasal prong interface) [22] with NAVA-NIV in comparison to PS-NIV as well as with improved synchrony recently demonstrated with helmet NAVA-NIV in comparison to helmet PS-NIV [23].…”

Section: Discussionsupporting

confidence: 88%

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Piquilloud

Tassaux

Bialais³

et al. 2012

Intensive Care Med

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Purpose: To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask. Methods: In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T d ), the patient's neural inspiratory time (T in ), ventilator pressurization duration (T iv ), inspiratory time in excess (T iex ), number of asynchrony events per minute and asynchrony index (AI) were determined. Results: The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T d was reduced with NAVA: median 35 ms (IQR 31-53 ms) versus 181 ms (122-208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T iex value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5-3.1 events/min) versus 4.4 events/min (0.9-12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5-10.5 %) versus 15.8 % (5.5-49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO 2 and PaCO 2 were not different between ventilatory modes. Conclusion: Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T d and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.

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Section: Discussionsupporting

confidence: 88%

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Piquilloud

Tassaux

Bialais³

et al. 2012

Intensive Care Med

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“…New ventilation modes have also been investigated, such as neurally adjusted ventilatory assist, in order to improve patient-ventilator interaction during NIV, as recently demonstrated by Cammarota and colleagues. 13 The success of NIV depends also on the kind of helmet. In recent years, many technological efforts have been made to improve helmet features in terms of design, material, and application systems, since it has been demonstrated 13 that the helmet's specific physical characteristics may significantly affect patient-ventilator interaction, suggesting that different helmets determine different ventilator performance, even if specific ventilator settings are applied.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the absence of wasted effort with the double tube circuit demonstrates the positive influence of the optimal circuit on patient-ventilator interaction and ventilator performance, as wasted effort generates patient discomfort, gas exchange deterioration, work of breathing increase, and rise in risk of NIV failure. [12][13][14][15][16][17] It is noteworthy that better interaction and performance determined significantly higher V T and neural V T values with the double tube circuit, compared to the standard circuit, at both breathing frequencies and ventilator settings, except at 30 breaths/min with the default setting; however, this condition was altered by the presence of wasted effort, which make the analysis unreliable. On the basis of our results, we suggest the use of a double tube circuit to connect the helmet to the ventilator during helmet NIV.…”

Section: Discussionmentioning

confidence: 99%

“…12 In the last years, many efforts have been made to improve helmet NIV, and several models of helmet with different designs and materials are now available for clin-ical use. 12 Moreover, ventilator technological improvements, such as specific softwares for NIV, new ventilator modes such as neurally adjusted ventilatory assist, 13 and various levels of inspiratory and expiratory triggers, 14 have also been proposed to minimize the impact of both air leaks and the helmet's intrinsic characteristics on patientventilator interaction.…”

Section: Introductionmentioning

confidence: 99%

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A Bench Study of 2 Ventilator Circuits During Helmet Noninvasive Ventilation

et al. 2013

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OBJECTIVE: To compare helmet noninvasive ventilation (NIV), in terms of patient-ventilator interaction and performance, using 2 different circuits for connection: a double tube circuit (with one inspiratory and one expiratory line) and a standard circuit (a Y-piece connected only to one side of the helmet, closing the other side). METHODS: A manikin, connected to a test lung set at 2 breathing frequencies (20 and 30 breaths/min), was ventilated in pressure support ventilation (PSV) mode with 2 different settings, randomly applied, of the ratio of pressurization time to expiratory trigger time (T press /T exp-trigger ) 50%/25%, default setting, and T press /T exp-trigger 80%/60%, fast setting, through a helmet. The helmet was connected to the ventilator randomly with the double and the standard circuit. We measured inspiratory trigger delay (T insp-delay ), expiratory trigger delay (T exp-delay ), T press ), time of synchrony (T synch ), trigger pressure drop, inspiratory pressure-time product (PTP), PTP at 300 ms and 500 ms, and PTP at 500 ms expressed as percentage of an ideal PTP500 (PTP500 index). RESULTS: At both breathing frequencies and ventilator settings, helmet NIV with the double tube circuit showed better patient-ventilator interaction, with shorter T insp-delay , T exp-delay , and T press ; longer T synch ; and higher PTP300, PTP500, and PTP500 index (all P < .01). CONCLUSIONS: The double tube circuit had significantly better patient-ventilator interaction and a lower rate of wasted effort at 30 breaths/min.

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“…NAVA has been reported to improve synchrony during NIV when a helmet is used. 146,147 Using an oronasal mask, Schmidt et al 148 reported that NAVA improved synchrony more than the use of NIV mode on a critical care ventilator. The combination of NAVA with the NIV mode seemed to offer the best compromise between good synchrony and a low level of leaks.…”

Section: Technical Aspects Which Interface?mentioning

confidence: 99%

Noninvasive Ventilation for Acute Respiratory FailureDiscussion

2013

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Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation

Abstract: Compared with PSV, NAVA improves patient-ventilator interaction and synchrony, with no difference in gas exchange, respiratory rate, and neural drive and timing.

Cited by 77 publications

References 29 publications

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

A Bench Study of 2 Ventilator Circuits During Helmet Noninvasive Ventilation

Noninvasive Ventilation for Acute Respiratory FailureDiscussion

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