Pressure support ventilation, sigh adjunct to pressure support ventilation, and neurally adjusted ventilatory assist in infants after cardiac surgery: A physiologic crossover randomized study

Abstract

Objectives: We sought to compare gas exchange, respiratory mechanics, and asynchronies during pressure support ventilation (PSV), sigh adjunct to PSV (PSV SIGH), and neurally adjusted ventilatory assist (NAVA) in hypoxemic infants after cardiac surgery.Design: Prospective, single-center, crossover, randomized physiologic study.Setting: Tertiary-care pediatric intensive care unit.Patients: Fourteen hypoxemic infants (median age 11.5 days [8.7-74]). Interventions:The protocol begins with a 1 hour step of PSV, followed by two consecutive steps in PSV SIGH and NAVA in random order, with a washout period of 30 minutes (PSV) between them.Main Results: Three infants presented an irregular Eadi signal because of diaphragmatic paralysis and were excluded from analysis. For the remaining 11 infants, PaO 2 /FiO 2 and oxygenation index improved in PSV SIGH compared with PSV (P < 0.05) but not in NAVA compared with PSV. PSV SIGH showed increased tidal volumes and lower respiratory rate than PSV (P < 0.05), as well as a significant improvement in compliance with respiratory system indexed to body weight when compared with both PSV and NAVA (P < 0.01). No changes in mean airway pressure was registered among steps. Inspiratory time resulted prolonged for both PSV SIGH and NAVA than PSV (P < 0.05). NAVA showed the higher coefficient of variability in respiratory parameters and a significative decrease in asynchrony index when compared with both PSV and PSV SIGH (P < 0.01). Conclusions:The adjunct of one SIGH per minute to PSV improved oxygenation and lung mechanics while NAVA provided the best patient-ventilator synchrony in infants after cardiac surgery. K E Y W O R D Sasynchronies, neurally adjusted ventilatory assist, pediatric cardiac surgery, pressure support ventilation, SIGH

Pressure Support Ventilation (PSV) versus Neurally Adjusted Ventilatory Assist (NAVA) in difficult to wean pediatric ARDS patients: a physiologic crossover study

“…In the abovementioned study [39], as in other studies [14,40], NAVA determined a significant reduction of peak inspiratory airway pressure and mean airway pressure when compared to conventional ventilation modes. In our study, peak inspiratory airway pressure was similar in all tested conditions, as we set the NAVA level to achieve similar peak inspiratory pressures to those observed during PSV.…”

“…Recent studies confirmed the clinical feasibility and advantages of NAVA in pediatric patients after cardiac surgery [38,39] especially in patients with difficult weaning.…”

Utilizing Spontaneous Ventilation Modes in Patients Underwent Corrective Surgery for Right Ventricular Outflow Tract Obstructive Congenital Heart Disease: A Crossover Study

“…These results are consistent with our previous study in children with single ventricles [ 14 ] and many other studies [ 12 , 15 , 16 , 17 ]. In some studies of the NAVA mode, children ventilated with the NAVA mode had lower airway pressures than children ventilated with the continuous positive airway pressure mode, suggesting that the NAVA mode used before weaning may be more appropriate than the other modes [ 18 , 19 ].…”

Application of neurally adjusted ventilatory assist in ventilator weaning of infants ventilator weaning

“…Moreover, it was found that the incidence rate of the asynchronous index (AI) in the PSV mode was 36%, which was significantly higher than that in the NAVA mode. These problems will reduce the comfort of mechanical ventilation and increase dependence on sedatives (Bonacina et al., 2019 ). The results showed that the asynchronous index of Nava model was significantly lower than that of CPAP mode.…”