Sleep quality in mechanically ventilated patients: comparison between NAVA and PSV modes

Abstract

BackgroundMechanical ventilation seems to occupy a major source in alteration in the quality and quantity of sleep among patients in intensive care. Quality of sleep is negatively affected with frequent patient-ventilator asynchronies and more specifically with modes of ventilation. The quality of sleep among ventilated patients seems to be related in part to the alteration between the capacities of the ventilator to meet patient demand. The objective of this study was to compare the impact of two modes of ventilation and patient-ventilator interaction on sleep architecture.MethodsProspective, comparative crossover study in 14 conscious, nonsedated, mechanically ventilated adults, during weaning in a university hospital medical intensive care unit. Patients were successively ventilated in a random ordered cross-over sequence with neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV). Sleep polysomnography was performed during four 4-hour periods, two with each mode in random order.ResultsThe tracings of the flow, airway pressure, and electrical activity of the diaphragm were used to diagnose central apneas and ineffective efforts. The main abnormalities were a low percentage of rapid eye movement (REM) sleep, for a median (25th-75th percentiles) of 11.5% (range, 8-20%) of total sleep, and a highly fragmented sleep with 25 arousals and awakenings per hour of sleep. Proportions of REM sleep duration were different in the two ventilatory modes (4.5% (range, 3-11%) in PSV and 16.5% (range, 13-29%) during NAVA (p = 0.001)), as well as the fragmentation index, with 40 ± 20 arousals and awakenings per hour in PSV and 16 ± 9 during NAVA (p = 0.001). There were large differences in ineffective efforts (24 ± 23 per hour of sleep in PSV, and 0 during NAVA) and episodes of central apnea (10.5 ± 11 in PSV vs. 0 during NAVA). Minute ventilation was similar in both modes.ConclusionsNAVA improves the quality of sleep over PSV in terms of REM sleep, fragmentation index, and ineffective efforts in a nonsedated adult population.

Effect of Ventilatory Variability on Occurrence of Central Apneas

“…13,14,19,48,49 In a recent comparison of the impact of NAVA and PSV on sleep architecture, we demonstrated that NAVA provided better sleep quality in terms of REM sleep, fragmentation index, and ineffective efforts in unsedated adults. 18 NAVA also allows considerable variability in the breathing pattern (ie, better replicates the variability of spontaneous breathing). We hypothesized that this greater variability, compared to PSV, decreased central apneas.…”

“…18 We conducted a prospective, interventional, crossover study in a 22-bed medical ICU at Hôpital du Sacré-Coeur over a 12-month period. Inclusion criteria were invasive mechanical ventilation, normal consciousness, absence of sedatives and opiates for Ն 24 h, and PSV with an F IO 2 below 0.60 and a PEEP of 5 cm H 2 O to achieve an S pO 2 of at least 90%.…”

Sleep in Intensive Care: Is there or not?

“…Yoğun bakımdaki hastalarda uyku kalitesi uygun ventilatör ayarları sağ-lanarak ve hasta ventilatör uyumsuzluğu azaltılarak düzeltilebilir (31)(32)(33)(34)(35). Hasta ventilatör uyumsuzluğu solunum desteğini kısıtlayarak veya proportional asist ventilasyon (PAV) ve neurally adjusted ventilatory asist (NAVA) gibi modlar kullanılarak da düzeltilebilir (33,34).…”

Advances in Ventilation — Neurally Adjusted Ventilatory Assist (NAVA)

“…32,33 In a cohort crossover study, patients ventilated with NAVA had a higher proportion of REM sleep and less fragmented sleep. 34 …”