Patient–Ventilator Asynchrony During Noninvasive Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist in Infants and Children

Vignaux, Laurence; Grazioli, Serge; Piquilloud, Lise; Bochaton, Nathalie; Karam, Oliver; Levy-Jamet, Yann; Jaecklin, Thomas; Tourneux, P.; Jolliet, Philippe; Rimensberger, Peter C.

doi:10.1097/pcc.0b013e3182917922

Cited by 51 publications

(113 citation statements)

References 28 publications

(34 reference statements)

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“…Previous studies with small numbers of patients and short study periods confirmed the superiority of NIV-NAVA mode compared with pressure support mode in infants and children (Ͻ 5 y old). 11 Our results show good synchronization and patient-ventilator interactions in NIV-NAVA mode in small infants weighing Ͻ 5 kg. This can offer better comfort for the patient because the ventilator tends to mimic the normal shapes of patient breathing and allows normal variations of respiration.…”

Section: Discussionsupporting

confidence: 55%

“…2 Adult and pediatric studies showed that NAVA increases breath-to-breath variability and improves patient-ventilator synchrony and patient comfort. [3][4][5][6][7][8][9] This last improvement is also effective in NIV in adult and pediatric subjects 10,11 and in very low birthweight infants, even in the presence of large leaks. 12 To our knowledge, no previous study was designed to evaluate this ventilation mode exclusively in the postoperative period after cardiac surgery in newborns.…”

Section: Introductionmentioning

confidence: 96%

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Feasibility Study on Neurally Adjusted Ventilatory Assist in Noninvasive Ventilation After Cardiac Surgery in Infants

et al. 2015

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BACKGROUND: Our objective was to evaluate the feasibility, the quality of synchronization, and the influence on respiratory parameters of the noninvasive neurally adjusted ventilatory assist (NIV-NAVA) mode in infants after cardiac bypass surgery. We conducted a prospective, randomized cross-over study in infants undergoing noninvasive ventilation (NIV) after cardiac surgery. METHODS: Subjects were 10 infants < 5 kg. After extubation, subjects underwent 2 consecutive ventilatory modes after randomization into groups. In the CPAP first group, the subjects were ventilated first in nasal CPAP-1 and then in NIV-NAVA-2 for 30 min in each mode. In the NIV-NAVA first group, periods were reversed. All children were ventilated using the same interface. RESULTS: The analysis of curves showed a synchronization rate of 99.3% for all respiratory cycles. The rate of pneumatic inspiratory trigger was 3.4%. Asynchronies were infrequent. Some typical respiratory patterns (continuous effort and discontinuous inspiration) were found at rates of 10.9% and 31.1%, respectively. The respiratory trends showed a lower maximum diaphragmatic electrical activity (EA di(max) ) in NIV-NAVA periods compared with CPAP periods (P < .001 in the beginning of periods). The breathing frequency decreased significantly during the nasal CPAP-2 and NIV-NAVA-1 periods (P < .05). The inspiratory pressure increased significantly during the NIV-NAVA-1 and NIV-NAVA-2 periods (P < .05), but there was no significant difference for each parameter when comparing ⌬ values between the beginning and the end of each period. The EA di signal was easy to obtain in all subjects, and no major side effects were associated with the use of NIV-NAVA. CONCLUSIONS: NIV-NAVA allows good synchronization in bi-level NIV in infant cardiac subjects weighing < 5 kg. The analysis of respiratory parameters shows that NIV NAVA decreases the work of breathing more effectively than nasal CPAP. The study shows some typical respiratory patterns in infants. (ClinicalTrials.gov registration NCT01570933.)

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Section: Discussionsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 96%

Feasibility Study on Neurally Adjusted Ventilatory Assist in Noninvasive Ventilation After Cardiac Surgery in Infants

et al. 2015

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“…The patient therefore determines their own respiratory rate (RR), tidal volume (V T ), peak inspiratory pressure (PIP), mean airway pressure, inspiratory and expiratory times 3,4 while improving synchrony even in the presence of air leaks existing from uncuffed endotracheal tubes. 5,6 In certain disease states, when the respiratory muscles are unable to maintain adequate ventilation and oxygenation, it may be advantageous to partially or totally transfer workload from the respiratory muscles to the ventilator while preventing fatigue and disuse atrophy of respiratory muscles. 7,8 The NAVA level is a proportionality factor that converts the Edi signal into a proportional pressure.…”

Section: Introductionmentioning

confidence: 99%

Effect of changing NAVA levels on peak inspiratory pressures and electrical activity of the diaphragm in premature neonates

Firestone

Fisher²,

Reddy

et al. 2015

J Perinatol

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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%

“…11,12 However, ventilator settings and interfaces used affect patient-ventilator synchrony in both cases. 13 Although neurally adjusted ventilatory assist (NAVA) has been proposed as a partial ventilatory support mode to improve patient-ventilator synchrony, 11,14,15 its use has been limited by the elevated cost of the catheter and need for specific equipment. Therefore, PSV still remains, in most adult and pediatric ICUs, the accepted standard for delivering partial ventilatory support during invasive and noninvasive ventilation.…”

Section: Introductionmentioning

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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Patient–Ventilator Asynchrony During Noninvasive Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist in Infants and Children

Cited by 51 publications

References 28 publications

Feasibility Study on Neurally Adjusted Ventilatory Assist in Noninvasive Ventilation After Cardiac Surgery in Infants

Feasibility Study on Neurally Adjusted Ventilatory Assist in Noninvasive Ventilation After Cardiac Surgery in Infants

Effect of changing NAVA levels on peak inspiratory pressures and electrical activity of the diaphragm in premature neonates

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

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