Work of Breathing in Premature Neonates: Noninvasive Neurally-Adjusted Ventilatory Assist versus Noninvasive Ventilation

Matlock, David N.; Bai, Shasha; Weisner, Michael D.; Comtois, Norman; Beck, Jennifer; Sinderby, Christer; Courtney, Sherry E.

doi:10.4187/respcare.07257

Cited by 9 publications

(6 citation statements)

References 28 publications

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“…The prevalence of BPD continues to be substantial despite significant advancements in neonatal care and contemporary ventilatory management [ 20 , 65 , 66 , 67 , 68 ]. Compared to CMV, NAVA has been found to improve patient–ventilator interaction and minimize asynchrony [ 2 , 17 , 18 , 28 , 35 ]. Improving patient–ventilator synchrony holds promise for the care of preterm neonates, as it has the potential to mitigate lung injury and may play a critical role in reducing the burden of BPD.…”

Section: Discussionmentioning

confidence: 99%

“…The magnitude of the patient’s respiratory demand on NAVA is synchronized between the patient and the ventilator [ 24 , 25 , 26 ]. Several clinical studies in neonates have demonstrated a significant improvement in synchrony between the patient and the ventilator when utilizing NAVA, whether invasive or noninvasive [ 17 , 18 , 27 , 28 , 29 , 30 ]. Moreover, up to the present moment, the Electrical Activity of the Diaphragm (EAdi) represents the earliest and foremost signal in the neural respiratory pathway (beginning from the central respiratory system, traversing the phrenic nerve, and concluding with diaphragmatic contraction), in contrast to changes in pressure or flow, which is, in fact, the last event in the neuro-respiratory course [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, up to the present moment, the Electrical Activity of the Diaphragm (EAdi) represents the earliest and foremost signal in the neural respiratory pathway (beginning from the central respiratory system, traversing the phrenic nerve, and concluding with diaphragmatic contraction), in contrast to changes in pressure or flow, which is, in fact, the last event in the neuro-respiratory course [ 25 ]. Additionally, reliance on flow or pressure sensors can be affected by leakage in the ventilator circuit and thus reduces the accuracy of both the monitoring and delivery of ventilatory assistance [ 17 , 18 , 27 , 28 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

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Optimizing Invasive Neonatal Respiratory Care: A Systematic Review of Invasive Neurally Adjusted Ventilatory Assist

Balasundaram,

Sakr

2024

Healthcare

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Background: Mechanical ventilation in preterm neonates aims for synchrony, preventing complications such as lung injury. Neurally Adjusted Ventilatory Assist (NAVA) is a unique mode relying on diaphragmatic electrical signals for synchronization. We conducted a review focusing on the long-term consequences of using invasive NAVA in neonates with a focus on bronchopulmonary dysplasia (BPD). Methods: A systematic review following PRISMA explored invasive NAVA in preterm neonates. Primary objectives compared NAVA to conventional ventilation, assessing BPD incidence, ventilation duration, length of stay, and adverse events. Secondary objectives analyzed ventilator parameters. Results: After screening 282 records, the review incorporated two randomized controlled trials for primary outcomes and seven trials for secondary outcomes, including two randomized crossovers, four prospective crossovers, and one retrospective study. NAVA showed reduced oxygen requirement at 28 days but no significant differences in oxygen need at 36 weeks postmenstrual age, total length of stay, or ventilator days. Substantial variations were not observed in adverse events. Ventilator variables favored NAVA, indicating decreased peak inspiratory pressure, tidal volume, work of breathing, and respiratory severity score. Conclusion: Our study found no significant reduction in BPD with NAVA despite short-term benefits. Future large-scale trials are essential to assess NAVA’s impact on long-term outcomes comprehensively.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimizing Invasive Neonatal Respiratory Care: A Systematic Review of Invasive Neurally Adjusted Ventilatory Assist

Balasundaram,

Sakr

2024

Healthcare

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“…We identified 24 potentially relevant reports, four of which (Kallio 2019 [23], Yagui 2019 [24], Makker 2020 [25], Shin 2022 [26]) met the inclusion criteria after full-text reviewing (Figure 1). We excluded 20 reports because the study intervention or design was different or the reports were clinical trial registries or trials were completed without available published results [10,11,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44].…”

Section: Study Selectionmentioning

confidence: 99%

Non-invasive neurally-adjusted ventilatory assist in preterm infants with respiratory distress: a systematic review and meta-analysis

Minamitani

Miyahara

Saito

et al. 2023

Preprint

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Non-invasive neurally-adjusted ventilatory assist (NIV-NAVA) improves patient-ventilator synchrony and reduces treatment failure in preterm infants compared with nasal continuous positive airway pressure (NCPAP) and non-invasive positive-pressure ventilation (NIPPV). We conducted a systematic review and meta-analysis to assess the effectiveness of NIV-NAVA in preterm infants with respiratory distress. Four investigators independently assessed the eligibility of studies in CENTRAL, CINAHL, ClinicalTrials.gov, Embase, MEDLINE, PubMed, and WHO ICTRP databases, and extracted data. The included studies were randomized controlled trials (RCTs) comparing NIV-NAVA with other non-invasive ventilation modalities in preterm infants. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach and four RCTs which examined 259 preterm infants were eligible to this study. In the subgroup of secondary use after extubation, NIV-NAVA reduces the risk of treatment failure compared with NCPAP/NIPPV (risk ratio 0.29; 95% confidence interval [0.10, 0.81], 2 RCTs, 96 infants, low certainty of the evidence). In the subgroup of primary use at birth, no statistically significant differences in treatment failure were observed (very low certainty of the evidence). Moreover, there were no significant differences in secondary outcomes. Therefore, NIV-NAVA may prevent treatment failure and the requirement of reintubation in preterm infants.

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“…The magnitude of the patient's respiratory demand on NAVA is synchronized between the patient and the ventilator [24][25][26]. Several clinical studies in neonates have demonstrated a significant improvement in synchrony between the patient and the ventilator when utilizing NAVA, whether invasive or noninvasive [17,18,[27][28][29][30]. Moreover, up to the present moment, the Electrical Activity of the Diaphragm (EAdi) represents the earliest and foremost signal in the neural respiratory pathway (beginning from the central respiratory system, traversing the phrenic nerve, and concluding with diaphragmatic contraction), in contrast to changes in pressure or flow, which is, in fact, the last event in the neurorespiratory course [25].…”

Section: Introductionmentioning

confidence: 99%

Optimizing Invasive Neonatal Respiratory Care: A Review of Invasive Neurally Adjusted Ventilatory Assist

Balasundaram,

Sakr

2024

Preprint

View full text Add to dashboard Cite

Background: Mechanical ventilation in preterm neonates aims for synchrony, preventing complications such as lung injury. Neurally Adjusted Ventilatory Assist (NAVA) stands out as a unique mode relying on diaphragmatic electrical signals for synchronization. We attempted to review studies that have explored the long-term consequence of using invasive NAVA in neonates with a specific focus on respiratory outcomes, namely bronchopulmonary dysplasia (BPD). Methods: A systematic review following PRISMA explored invasive NAVA in preterm neonates. Primary objectives compared NAVA to conventional ventilation, assessing BPD incidence, ventilation duration, length of stay, and adverse events. Secondary objectives analyzed ventilator parameters. Results: After screening 282 records, nine studies were included. NAVA showed reduced oxygen requirement at 28 days but no significant differences in oxygen need at 36 weeks postmenstrual age, total length of stay, or ventilator days. Adverse events such as air leak, mortality, patent ductus arteriosus, and intraventricular hemorrhage revealed no substantial variations. Ventilator variables favored NAVA, indicating decreased peak inspiratory pressure, tidal volume, work of breathing, and respiratory severity score. Conclusion: Despite short-term benefits, our study found no significant reduction in BPD with NAVA. Future large-scale trials are essential to comprehensively assess NAVA's impact on preterm infants' long-term outcomes.

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Work of Breathing in Premature Neonates: Noninvasive Neurally-Adjusted Ventilatory Assist versus Noninvasive Ventilation

Cited by 9 publications

References 28 publications

Optimizing Invasive Neonatal Respiratory Care: A Systematic Review of Invasive Neurally Adjusted Ventilatory Assist

Optimizing Invasive Neonatal Respiratory Care: A Systematic Review of Invasive Neurally Adjusted Ventilatory Assist

Non-invasive neurally-adjusted ventilatory assist in preterm infants with respiratory distress: a systematic review and meta-analysis

Optimizing Invasive Neonatal Respiratory Care: A Review of Invasive Neurally Adjusted Ventilatory Assist

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