Patient-ventilator synchrony in Neurally Adjusted Ventilatory Assist (NAVA) and Pressure Support Ventilation (PSV): a prospective observational study

Yonis, Hodane; Crognier, Laure; Conil, Jean‐Marie; Serres, Isabelle; Rouget, Antoine; Virtos, Marie; Cougot, P.; Minville, Vincent; Fourcade, Olivier; Georges, Bernard

doi:10.1186/s12871-015-0091-z

Cited by 56 publications

(58 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Double triggering was more common in NAVA than in PSV. This result is consistent with results obtained in other studies [26,47]. The presence of double triggering in NAVA is related to EAdi signal showing a biphasic curve.…”

Section: Discussionsupporting

confidence: 93%

Neurally adjusted ventilatory assist vs. pressure support to deliver protective mechanical ventilation in patients with acute respiratory distress syndrome: a randomized crossover trial

Diniz-Silva

Moriya²,

Alencar

et al. 2020

Ann. Intensive Care

View full text Add to dashboard Cite

Background: Protective mechanical ventilation is recommended for patients with acute respiratory distress syndrome (ARDS), but it usually requires controlled ventilation and sedation. Using neurally adjusted ventilatory assist (NAVA) or pressure support ventilation (PSV) could have additional benefits, including the use of lower sedative doses, improved patient-ventilator interaction and shortened duration of mechanical ventilation. We designed a pilot study to assess the feasibility of keeping tidal volume (V T ) at protective levels with NAVA and PSV in patients with ARDS. Methods:We conducted a prospective randomized crossover trial in five ICUs from a university hospital in Brazil and included patients with ARDS transitioning from controlled ventilation to partial ventilatory support. NAVA and PSV were applied in random order, for 15 min each, followed by 3 h in NAVA. Flow, peak airway pressure (Paw) and electrical activity of the diaphragm (EAdi) were captured from the ventilator, and a software (Matlab, Mathworks, USA), automatically detected inspiratory efforts and calculated respiratory rate (RR) and V T . Asynchrony events detection was based on waveform analysis. Results:We randomized 20 patients, but the protocol was interrupted for five (25%) patients for whom we were unable to maintain V T below 6.5 mL/kg in PSV due to strong inspiratory efforts and for one patient for whom we could not detect EAdi signal. For the 14 patients who completed the protocol, V T was 5.8 ± 1.1 mL/kg for NAVA and 5.6 ± 1.0 mL/kg for PSV (p = 0.455) and there were no differences in RR (24 ± 7 for NAVA and 23 ± 7 for PSV, p = 0.661). Paw was greater in NAVA (21 ± 3 cmH 2 O) than in PSV (19 ± 3 cmH 2 O, p = 0.001). Most patients were under continuous sedation during the study. NAVA reduced triggering delay compared to PSV (p = 0.020) and the median asynchrony Index was 0.7% (0-2.7) in PSV and 0% (0-2.2) in NAVA (p = 0.6835).

show abstract

Section: Discussionsupporting

confidence: 93%

Neurally adjusted ventilatory assist vs. pressure support to deliver protective mechanical ventilation in patients with acute respiratory distress syndrome: a randomized crossover trial

Diniz-Silva

Moriya²,

Alencar

et al. 2020

Ann. Intensive Care

View full text Add to dashboard Cite

show abstract

“…77 A recent prospective study focusing on patient-ventilator asynchronies in NAVA and pressure support ventilation showed how NAVA reduced the risk of over-and undersupport while providing more physiological ventilation with tidal volume variability than pressure support ventilation. 78 The recent commercial spread of NAVA has given the opportunity to obtain simple and minimally invasive monitoring of E di , so that this index can be used to monitor patient inspiratory activity during any mode of ventilation, 79 based on the tight proportionality between E di and P mus . 80 One study 73 proposed the combined use of P mus and E di , previously termed neuromechanical efficiency, which is supposed to indicate the amount of pressure that respiratory muscles are generating for a unit of electrical activity.…”

Section: Electrical Activity Of the Diaphragmmentioning

confidence: 99%

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

View full text Add to dashboard Cite

The majority of patients admitted to the ICU require mechanical ventilation as a part of their process of care. However, mechanical ventilation itself or the underlying disease can lead to dysfunction of the diaphragm, a condition that may contribute to the failure of weaning from mechanical ventilation. However, extended time on the ventilator increases health-care costs and greatly increases patient morbidity and mortality. Nevertheless, symptoms and signs of muscle disease in a bedridden (or bed rest-only) ICU patient are often difficult to assess because of concomitant confounding factors. Conventional assessment of diaphragm function lacks specific, noninvasive, time-saving, and easily performed bedside tools or requires patient cooperation. Recently, the use of ultrasound has raised great interest as a simple, noninvasive method of quantification of diaphragm contractile activity. In this review, we discuss the physiology and the relevant pathophysiology of diaphragm function, and we summarize the recent findings concerning the evaluation of its (dys)function in critically ill patients, with a special focus on the role of ultrasounds. We describe how to assess diaphragm excursion and diaphragm thickening during breathing and the meaning of these measurements under spontaneous or mechanical ventilation as well as the reference values in health and disease. The spread of ultrasonographic assessment of diaphragm function may possibly result in timely identification of patients with diaphragm dysfunction and to a potential improvement in the assessment of recovery from diaphragm weakness.

show abstract

“…Derzeit ist es noch zu früh, um eine endgültige Beurteilung des NAVAModus abgeben zu können, auch wenn pathophysiologische Studien an Tieren und Patienten einen Vorteil gegenüber den bisherigen assistierten Beatmungsmethoden nahelegen [23,24]. Zu fordern sind prospektive randomisierte Studien, um den Wert von NAVA im Vergleich zu den etablierten Beatmungsverfahren näher definieren zu können.…”

Section: "Neurally Adjusted Ventilatory Assist"unclassified