Randomized Crossover Study of Neurally Adjusted Ventilatory Assist in Preterm Infants

Lee, Juyoung; Kim, Han Suk; Sohn, Jung Woo; Lee, Jin A; Choi, Chang Won; Kim, Ee Kyung; Kim, Beyong Il; Choi, Jung Hwan

doi:10.1016/j.jpeds.2012.04.040

Cited by 81 publications

(90 citation statements)

References 22 publications

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“…Stein et al [70] reported in a retrospective study that preterm infants managed on NAVA mode maintained better blood gases using lower PIP and FiO 2 values when compared to SIMV plus pressure support (SIMV+PS) mode of ventilation. Lee et al [71] also recently reported in a randomized crossover study that NAVA lowered required PIP values and reduced the respiratory muscle load in preterm infants when compared to SIMV+PS. NAVA mode is also available for use in with noninvasive ventilation (NIV-NAVA).…”

Section: Neurally Adjusted Ventilatory Assist (Nava)mentioning

confidence: 89%

Non-Invasive Ventilation and Surfactant Therapy

Ramanathan

Paz²,

Biniwale³

2013

J Pulm Respir Med

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The lungs of premature infants are more vulnerable than term infants to the effects of invasive positive pressure ventilation. Published literature supporting the use of non-invasive respiratory support with CPAP, bi-level CPAP mode, such as, SiPAP and Nasal Intermittent Positive Pressure Ventilation (NIPPV), and surfactant administration strategies are discussed. This review focuses on non-invasive respiratory support strategies and selective early use of surfactant that may reduce the incidence of bronchopulmonary dysplasia. Invasive VentilationBronchopulmonary Dysplasia (BPD) remains major pulmonary morbidity in preterm infants with Respiratory Distress Syndrome (RDS), especially among the Extremely Low Birth Weight (ELBW) infants, [1] and is associated with short-and long-term adverse pulmonary and non-pulmonary outcomes. Advances in perinatal care, including antenatal corticosteroid use, advances in invasive mechanical ventilation modes, and postnatal surfactant therapy have significantly decreased the severity of RDS and neonatal mortality. Despite these changes, invasive ventilation via an endotracheal tube remains as one of the major reasons for the development of BPD. Prophylactic or rescue surfactant therapy alone has not been shown to decrease BPD rate. Noninvasive respiratory support modes, especially bilevel CPAP or SiPAP mode, have not been shown to impact BPD rate. However, use of early, rescue surfactant therapy and NIPPV mode has been shown to decrease BPD rate. This review will focus on the benefits of surfactant therapy used in combination with NIPPV mode of respiratory support in preterm infants.

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Section: Neurally Adjusted Ventilatory Assist (Nava)mentioning

confidence: 89%

Non-Invasive Ventilation and Surfactant Therapy

Ramanathan

Paz²,

Biniwale³

2013

J Pulm Respir Med

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“…In a recent randomized trial, NAVA was compared with synchronized intermittent mandatory ventilation plus pressure support; however, the duration of the trial was 4 h and the preterm infants enrolled were not acutely ill [11]. In keeping with previous physiologic studies comparing NAVA with conventional modes in neonates [6,10,11,12], we found that Paw peak was significantly lower with NAVA, as opposed to PRVC, either overall and at each corresponding epoch (fig.…”

Section: Discussionmentioning

confidence: 99%

“…Based on previously published data showing a reduction in Paw peak of 1 cmH 2 O after 4 h of ventilation [11], we calculated the sample size to observe at least the same reduction during a longer study period (12 h) using paired measurements on the same patients; the sample size turned out to be 14 (Wilcoxon H test, α = 0.05, power = 80%).…”

Section: Methodsmentioning

confidence: 99%

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Neurally Adjusted Ventilatory Assist in Preterm Neonates with Acute Respiratory Failure

Longhini¹,

Ferrero

Luca

et al. 2014

Neonatology

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Background: Neurally adjusted ventilatory assist (NAVA) is a novel mode of ventilation that has been demonstrated to improve infant-ventilator interaction, compared to the conventional modes in retrospective and short-term studies. Objectives: To prospectively evaluate the physiologic effects of NAVA in comparison with pressure-regulated volume control (PRVC) in two nonrandomized 12-hour periods. Methods: We studied 14 consecutive intubated preterm neonates receiving mechanical ventilation for acute respiratory failure. Peak airway pressure (Paw_peak), diaphragm electrical activity (EAdi), tidal volume (V_T), mechanical (RR_mec) and neural (RR_neu) respiratory rates, neural apneas, and the capillary arterialized blood gases were measured. The RR_mec-to-RR_neu ratio (MNR) and the asynchrony index were also calculated. The amount of fentanyl administered was recorded. Results: Paw_peak and V_T were greater in PRVC (p < 0.01). Blood gases and RR_mec were not different between modes, while RR_neu and the EAdi swings were greater in NAVA (p = 0.02 and p < 0.001, respectively). MNR and the asynchrony index were remarkably lower in NAVA than in PRVC (p = 0.03 and p < 0.001, respectively). 1,841 neural apneas were observed during PRVC, with none in NAVA. Less fentanyl was administered during NAVA, as opposed to PRVC (p < 0.01). Conclusions: In acutely ill preterm neonates, NAVA can be safely and efficiently applied for 12 consecutive hours. Compared to PRVC, NAVA is well tolerated with fewer sedatives.

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“…69 More recently, 2 crossover studies have revealed that neurally adjusted ventilatory assist, where the ventilator is triggered by the electrical activity of the diaphragm, improves synchronization and gas exchange in preterm infants. 70,71 Future RCTs need to reveal whether this new technology also improves long-term outcomes. Nasal high frequency oscillatory ventilation (nHFOV) is another promising form of noninvasive respiratory support, which avoids the problem of breath synchronization.…”

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confidence: 99%

Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis

2013

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Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis abstract BACKGROUND AND OBJECTIVE: Mechanical ventilation via an endotra-cheal tube is a risk factor for bronchopulmonary dysplasia (BPD), one of the most common morbidities of very preterm infants. Our objective was to investigate the effect that strategies to avoid endotracheal mechanical ventilation (eMV) have on the incidence of BPD in preterm infants ,30 weeks' gestational age (GA). METHODS: In February 2013, we searched the databases Medline, Embase, and the Cochrane Central Register of Controlled Trials. Study selection criteria included randomized controlled trials published in peer-reviewed journals since the year 2000 that compared preterm infants ,30 weeks' GA treated by using a strategy aimed at avoiding eMV with a control group in which mechanical ventilation via an endotracheal tube was performed at an earlier stage. Data were extracted and analyzed by using the standard methods of the Cochrane Neonatal Review Group. The authors independently assessed study eligibility and risk of bias, extracted data and calculated odds ratios and 95% confidence intervals, employing RevMan version 5.1.6. RESULTS: We identified 7 trials that included a total of 3289 infants. The combined odds ratio (95% confidence interval) of death or BPD was 0.83 (0.71-0.96). The number needed to treat was 35. The study results were remarkably homogeneous. Avoiding eMV had no influence on the incidence of severe intraventricular hemorrhage.

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Randomized Crossover Study of Neurally Adjusted Ventilatory Assist in Preterm Infants

Cited by 81 publications

References 22 publications

Non-Invasive Ventilation and Surfactant Therapy

Non-Invasive Ventilation and Surfactant Therapy

Neurally Adjusted Ventilatory Assist in Preterm Neonates with Acute Respiratory Failure

Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis

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